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Full text of "United States Navy Medical News Letter Vol. 44 No. 6, 18 September 1964"

NAVMED P-5088 




Vol.44 



Friday, 18 September 1964 



No. 6 




TABLE OF CONTENTS 



SPECIAL FEATURES 

A Message from the Surgeon General 1 

The National Naval Medical Center 2 



MF.D1CAL ABSTRACTS 

History Taking in Urology 4 

Psychosomatic Diagnosis 7 



MISCELLANY 

Active Duty Medical Officers in Private Practice 10 

HM1 Strack Honored 11 

ADM Kreuz to Host Navy Party 11 

Applications for Inservice Residency Training 11 

Oak Knoll Trains Civilian Nurses 11 

Certification Program for Biophotographers 12 

Safety Message 12 



FROM THE NOTE BOOK 

Pharmaceutical Seminar Program 13 

Residency Program in Thoracic Surgery 13 

Meeting of ACS 13 

USNRDL Scientist Invited to Europe 13 



DENTAL SECTION 

Lymphadenopathy and Submaxillary Salivary Gland 

Pathology 14 

Manual and Power Toothbrushes 14 

Fluoridation Values in Adults 15 

Contamination in Dental Mercury 16 

Periodontal Disease and Prevention 16 

Professional Notes 17 

PREVENTIVE MEDICINE 

Animal Salmonellosis 19 

Antimony Poisoning-Illinois 20 

Anopheles Balabacensis in Cambodia 20 

Extracting Scorpion Venom 20 

Rocky Mountain Spotted Fever, Virginia 21 

Know Your World 21 

Warning About Tularemia 22 

Water Treatment Processes 23 

U.S. President Pledges Support for Tuberculosis Work 23 

Treatment of Rabies Infected Wounds 23 

RESERVE SECTION 

ACDUTRA Orders Standardized 25 

New Hospital Corps Division 25 

American College of Surgeons 25 

BUMED INST. 1001. IB 25 

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United States Navy 
MEDICAL NEWS LETTER 



Vol. 44 



Friday, IS September 1964 



No. 6 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Rear Admiral R. B. Brown MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
William A. Kline, Managing Editor 



Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain K. W. Schenck MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 






Policy 

The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 
addresses. 



FRONT COVER: This is perhaps the most widely known view of the main tower and adjoining buildings of the 
National Naval Medical Center. It is an official U.S. Navy Photograph taken by Mr. John Stringer, Head of the 
Medical Photography Laboratory, U.S. Naval Medical School, NNMC, Bethesda, Maryland 20014. 



The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 

U.S. NAVY MEDICAL NEWS LETTER 







THE SURGEON GENERAL OF THE NAVY 

WASHINGTON 



SEP c j 13W 



A MESSAGE TO ALL MEDICAL DEPARTMENT PERSONNEL 

Introducing the New Format of the U.S. Navy Medical News Letter 



The first issue of our Medical News Letter was distributed to Medical Department personnel around the World 
on 5 March 1943. It was conceived as a periodical publication designed to invite the attention of Regular and 
Reserve personnel of all ranks and rates, to timely and important items of official and professional interest rela- 
tive to the field of medicine and its allied sciences. It has been published without interruption since that date, 
including the periods of our major engagements of World War II and the Korean Conflict. Being remote from 
adequate medical libraries, our medical and allied sciences personnel serving with the combatant forces were in 
dire need of "keeping up" with progress at home in their respective fields. It has never been intended or assumed 
that the material published in the Medical News Letter would be a worthy substitute for original contributions to 
the medical and paramedical literature. It is an "in-house" or intramural periodical which covers U.S. Naval medi- 
cal affairs and current medical literature. The quality of the contents is directly proportional to the devoted 
interest and contributions of each and every person in the Medical Department of the U.S. Navy. 

From 1907 to 1949, the U.S. NAVAL MEDICAL BULLETIN was published continuously, and this Bureau 
enjoyed considerable prestige as a consequence of its excellent format and coverage of salient military medical prog- 
ress of the times, — contributed, almost without exception, by far-seeing and astute medical officers of the U. S. 
Navy. Today, scarcely a week passes in BUMED without multiple requests for reprints of articles or copies of that 
publication pertaining to pin-pointed problems, especially those related to tropical medicine. I would like to 
revive some of the Bulletin's features in our new Medical News Letter. 

With this new format, it is my fond hope and desire, (as well as my open invitation), that more of our 
accomplished personnel will take pen in hand to compose significant medical news items or professional articles 
for publication in this medium. It is well to remember that your word will be passed along to at least 15,000 to 
20,000 persons in the CONUS and abroad. In another frame of reference, let others benefit from your experi- 
ences. 

It is a pleasure to report that this new format is a direct result of the far-sighted initiative and planning of 
key personnel of the U.S. Navy Publications and Printing Service, Mr. A. N. Spence, Director, and his staff 
assistants Mr. Richard Furbush, Mr. Jack Richey and Mrs, Addie Wilson. In BuMed, I would like to express 
appreciation to the following personnel for their unswerving devotion to the perpetuation and improvement of 
the Medical News Letter: Captains M. W. Arnold (Editor), C. E. Wilbur (AVN Med), J. W. Millar (Preven- 
tive Med); K. W. Schenck (U.S. Naval Reserve), and C. A. Ostrom (Dental); CDR N. E. Rosenwinkel 
(Occupational Med), and CDR J. H. Schulte (Radiation Med and Submarine Med); Mr. William Kline (Man- 
aging Editor), and Mrs. Patricia Caballero and Miss Virginia Morvay, Assistants to Captain Arnold. 

The United States Navy Medical News Letter is YOUR publication. Let us see to it that you are an integral 
and contributing component of it. 



c&r. 




c * <• •*. * "*' 



U.S. NAVY MEDICAL NEWS LETTER 



E. C. KENNEY 
Surgeon General 
Rear Admiral MC USN 



m '• k 



1. 



A Report on the National Naval Medical Center, 

Bethesda, Maryland 



Submitted by RADM Calvin B. Galloway MC USN, Commanding Officer 



GENERAL 



The National Naval Medical Center was first estab- 
lished in 1935 and consisted of the Naval Hospital, and 
the Naval Medical School located at 23rd and E Streets, 
N.W., Washington, D. C, the present site of the Bureau 
of Medicine and Surgery. In 1938 money was appro- 
priated for the acquisition of land in the District of 
Columbia, or the vicinity thereof, for the building of a 
new Naval Medical Center. The site, selected from 
among 80 others inspected, consists of 242.4 acres lo- 
cated approximately one mile north of Bethesda, Md., 
on Rockville Pike (U.S. Route 240), opposite the Na- 
tional Institutes of Health. 

The site of the National Naval Medical Center is on 
one of the earliest grants of land in the Bethesda area. 
Originally known as "Leeke Forest," the land now 
occupied by the Center was part of a 710 acre tract of 
land surveyed for Colonel Henry Dulaney in 1688. It 
was also called "Darnall's Forest" when Colonel Henry 
Darnall secured a grant of 712 acres on November 12, 
1694. Colonel Henry Dulaney and Colonel Henry 
Darnall were owners of large tracts of land and holders 
of extensive "patents" on land throughout Maryland. 
Portions of the original "Leeke Forest" were later 
granted to Andrew Hughs and to Henry Leek, who had 
185 acres of "Leek's Lot" surveyed, and secured a 
patent for the 185 acres on March 28, 1747. 

GROUNDBREAKING 

The contracts for the construction of the Center were 
awarded and ground was broken with appropriate cere- 
monies on June 29, 1939. Actual construction was 
started soon thereafter. The cornerstone was laid on 
Armistice Day, 1940, by President Franklin Delano 
Roosevelt in the presence of the Secretary of the Navy 
and his staff, the chiefs of the various bureaus of the 
Navy Department, the Surgeons General of the Army 
and Public Health Service, and many other distin- 
guished guests, including members of Congress and of 
the medical profession. 

COMMISSIONING 

The newly constructed Medical Center was officially 
commissioned February 5, 1942, and the medical facili- 
ties thereat established by the Secretary of the Navy 
as the National Naval Medical Center, Bethesda, Md. 
On August 31, 1942, it was dedicated by President 
Roosevelt, which occasion also commemorated the 
100th anniversary of the Bureau of Medicine and 
Surgery. 



ARCHITECTURE 

The buildings are of structural steel, faced with pre- 
cast-exposed aggregate concrete panels. At a distance 
the dark spandrels, vertically situated between the win- 
dows, serve to give the main building the appearance 
of having lofty square columns. The style is monu- 
mental, and its balanced beauty gives the observer a 
sense of quietness and repose. Various-colored terra 
cotta is extensively used in the interior corridors and 
rooms with a most harmonious effect. The lobby walls 
are of Vermont marble in three colors trimmed with 
white bronze. 

The tower of the administration building, which is 
on a bluff facing Rockville Pike, dominates the land- 
scape for many miles in all directions. It rises 558 feet 
above "Rockville Pike," and is devoted to wards and 
sick rooms. 

A "carillon" system broadcasts chimes and re- 
corded programs daily through a battery of powerful 
amplifiers mounted on the tower roof. Under normal 
atmospheric conditions, the tones carry clearly over a 
range of two miles in every direction. A ship's clock, 
operating on this system, automatically strikes "ship's 
bells" on the hour and half-hour from seven a.m. to 
nine p.m. daily. 

The administration building has a west frontage of 
approximately 362 feet and is bounded on the north 
and south by three-story wings which extend from the 
building to a distance of about 158 feet. The tower 
floors are in the shape of a Geneva Cross, the greatest 
length being approximately 1 06 feet. 

The Medical Center consists of a central group of 
buildings housing the administrative offices, laboratories, 
classrooms, a surgical pavilion, two ward buildings, a 
dining hall and food-preparation area, and an audi- 
torium with a seating capacity of about 550. 

LANDSCAPING 

The landscaping is accomplished with trees native to 
this section of the country, such as oaks, elms, syca- 
mores and magnolias. A nine-hole golf course encircles 
the buildings. The golf course adds to the natural con- 
tour and beauty of the grounds, and provides a popular 
outdoor recreation facility for patients and staff. There 
is a small artificial lake fed by natural springs, located 
directly beneath the tower and in the center of the front 
lawn which has been popularly called Lake Eleanor in 
honor of the first lady of the land at the time the 
Center was built and commissioned. In addition, an 
artificial lake and recreation area were developed in the 
wooded area in the eastern portion of the reservation 



U.S. NAVY MEDICAL NEWS LETTER 




BACK VIEW OF NNMC, SHOWING NEW CONSTRUCTION 
Official U.S. Navy Photograph by Mr. John Stringer, U.S. Naval Medical School 



in 1954. The lake and recreation area, named in honor 
of Rear Admiral L. O. Stone MC USN, former Com- 
manding Officer of the Center, has facilities for wading, 
boating and fishing. The adjacent recreation area is 
equipped with picnic tables, barbecue pits and benches. 
This beautiful recreation area is the setting for the 
annual Easter Sunrise Services sponsored jointly by the 
Bethesda Council of Churches and the National Naval 
Medical Center. Sponsorship of the Easter Services 
by the Bethesda Council of Churches began in 1947 
with services being held directly in front of the main 
building. However, the setting of iofty pine trees, mir- 
rored in the clear waters of the lake, conveyed the im- 
pression of a lofty cathedral, and wooed planners of the 
event to this inspiring location. 

COMMAND CHARACTERISTICS 

The National Naval Medical Center is commanded 
by an officer of the Medical Corps, who exercises mili- 
tary and management control over the following activi- 
ties: U.S. Naval Hospital; U.S. Naval Medical School; 
U.S. Naval Medical Research Institute; U.S. Naval 



Dental School; U.S. Naval School of Hospital Adminis- 
tration; U.S. Navy Toxicology Unit, and the Armed 
Forces Radiobiology Research Institute. These compo- 
nent activities, with the exception of the Armed Forces 
Radiobiology Research Institute, are commanded by 
senior officers of the Medical, Dental, and Medical 
Service Corps of the U.S. Navy. The organizational 
structure of the Armed Forces Radiobiology Research 
Institute is that of a Directorate, consisting of a Direc- 
tor and two deputy directors representing the three 
branches of the Armed Services. 

The Naval Hospital, Naval Medical School, and 
Naval Dental School are housed principally in the cen- 
tral group of buildings. New construction to replace 
World War II temporary ward buildings began in Au- 
gust 1960, and was completed in the summer of 1963. 

Separated from the above enumerated buildings are 
the Naval Medical Research Institute; the U.S. Naval 
School of Hospital Administration; the U.S. Navy Toxi- 
cology Unit; and the Armed Forces Radiobiology Re- 
search Institute; utility buildings; officers' and nurses' 
quarters; enlisted quarters; and the recreation building. 



U.S. NAVY MEDICAL NEWS LETTER 



ROLE OF PRESIDENT ROOSEVELT IN 
ORIGIN OF NNMC 

Excerpts from "The Military Surgeon," 107(4): October 

1950, The Navy Builds a Medical Center, by Rear 

Admiral Lucius W. Johnson, MC USN, Retired. 

"We will build it here." 

"President Franklin D. Roosevelt leaned over the 
side of the automobile as he spoke, and struck the 
ground with his cane. It was the afternoon of July 5, 
1938, and the car stood in the cabbage patch of a run- 
down farm near Bethesda, Maryland. From this slight 
elevation could be seen the green fields sloping down 
toward the Rockville Pike, 300 feet away. A half-mile 
stretch of the road could be seen, and beyond it lay 



the carefully landscaped grounds of the Public Health 
Service, also a neighboring estate. 

"By this gesture and this decision on the site for the 
Naval Medical Center, a long period of anxious uncer- 
tainty was ended. The President was reported to have 
said the next morning, "Perhaps we were too precipitate 
about that site. Maybe it's too far out in the country." 

"Another feature was the spring and spring house 
located in a gully between the main building and the 
road. The bubbling pool and the tiny stream reminded 
the President of the Pool of Bethesda, in Jerusalem 
(John V, 2). Bethesda means "House of Mercy." 

"In December 1937 he had drawn for Surgeon Gen- 
eral Rossiter an elevation and ground plan of the build- 
ing he visualized for the Medical Center, and this be- 
came our guide." (NOTE: Facsimiles of these plans 
will be published in a subsequent News Letter.) 



History Taking in Genito-Urinary Disorders 

B. G. Clarke, MD*, Associate Professor of Urology, Tufts University School of Medi- 
cine and J. Hartwell Harrison, MD**, Clinical Professor of Genito-Urinary Surgery, 
Harvard Medical School. Reprinted by permission of the authors from "Diseases of 
the Urinary and Genital Organs" (A Review and Bibliography) — pps 2-8, Boston, Mass., 
I960.*** 



In all fields of medicine the history is a most impor- 
tant key to accurate diagnosis of disease processes. It 
serves to guide not only the initial investigations but 
treatment as well. After careful evaluation of symp- 
toms and physical findings, diagnosis can be established 
with exceptional accuracy in genito-urinary diseases by 
the combined use of the laboratory, radiographic aids 
and cystoscopic investigation. Urology offers to the stu- 
dent methods and facilities that enable the actual meas- 
urement of changes brought about by disease to be con- 
trasted with the normal. 

PAIN 

Pain arising from the kidneys and ureters usually is 
located in the flank, lower anterior abdomen, or groin. 
Similar pain can be caused by disease of the gall- 
bladder, bowel, pancreas, appendix, ovaries or tubes. 
Stimuli from the middle ureter may cause radiation 
of pain to the testis and from the intramural ureter to 
the glans penis. Pain from the testis or epididymis may 
not only be local in site, but radiate to the groin or 
abdomen. Pain from bladder, prostate or urethra has 
variable sites of reference, which may be elicited by 
careful questioning. 

The patient must be persuaded to describe not only 
the location of pain, but the circumstances of its onset, 
its duration, whether or not it is persistent or inter- 
mittent, whether it radiates or migrates, and whether 
or not the patient has discovered that it may be pre- 



cipitated or relieved by changes in posture or by some 
other factor. Within the genito-urinary organs pain 
can be caused by obstruction, by inflammation, by 
ischemia, or by tumor of a particular structure. 

FEVER 

Fever, characteristically, is a sign of spreading infec- 
tion in kidneys, prostate, or gonads. It may also result 
from primary or metastatic tumor, especially of the 
kidney, or from ischemic necrosis of any of the uro- 
genital organs. 

MASSES 

In the genito-urinary system a mass may represent 
a neoplasm, a cyst, a herniation, an inflammation or 
abscess, an ectopic organ, a tumor metastasis, or an 
aneurysm. When interviewing a patient about a mass 
it is important to learn its location and duration, 
whether or not it changes or has changed in size, and, 
if so, under what circumstances, and whether or not it 
is painful. 

ABNORMAL MICTURITION 

In the adult, the normal urinary bladder has a capac- 
ity of 300 to 500 cc. It empties completely during 
voluntary voiding which may be initiated at will. The 
normal individual voids three or four times during the 



Fever and Anemia in Renal Cancer. Clarke, B. G., and Goade, 
W. J., Jr.: New England 3 Med 254: 107-110, January 19, 1956 



U.S. NAVY MEDICAL NEWS LETTER 



day and not at all during the night except after an 
excessive intake of fluids. He experiences a character- 
istic urge to void which can be suppressed, voluntarily, 
for a considerable length of time. Deviation from this 
pattern betokens disorder. Careful questioning about 
micturitional abnormality reveals much about the char- 
acter and anatomic location of the cause. 

Thoughtful interpretation of symptoms of abnormal 
micturition yields much information about its cause. 
Frequent, urgent, painful micturition is due usually to 
inflammation of the bladder and, in the male patient, 
of the prostate gland. Tenesmus or spasm at the con- 
clusion of voiding is due to disease of the vesical out- 
let and may be followed by a few drops of blood. 
Diminished force and caliber of the urinary stream indi- 
cate obstruction. It may be accompanied by hesitant 
initiation or intermittent cessation of flow as well as by 
dribbling at the end of voiding. 

Hematuria appearing in the first part of the voided 
urine usually originates from the urethra or prostate. 
Blood homogenously mingled in the urine usually comes 
from diseased kidneys, ureters or bladder. Frequent 
voiding may result from a small capacity of the bladder, 
from hyperactive voiding reflexes, from overirritability 
of the bladder resulting from inflammatory disease, or 
from repeated ineffective attempts to void when the 
bladder is overfilled as the result of obstruction or of 
paralysis due to spinal cord disease. Careful evaluation 
of these nuances of the history is, when combined with 
the physical examination, extremely useful to the ex- 
aminer. 

PHYSICAL EXAMINATION IN UROLOGTC 
DISORDERS 

The physical examination of the patient with sus- 
pected disease of the urinary system has the same 
requirements as does correct physical examination gen- 
erally. Good illumination is essential. The patient 
should be as comfortable and relaxed as possible. Effi- 
cient and systematic observation are essential. Haste 
defeats itself. Inspection and palpation, aided by per- 
cussion and auscultation are each important. In all 
situations, the examiner must have in mind a clear 
mental picture of the normal anatomic location, struc- 
ture, and relations of the organ he is examining. 

Examination of the abdomen, inguinal region, and 
scrotum should be made in the supine and standing 
positions. Examination of the kidneys and retroperi- 
toneal areas is accomplished with the patient supine 
and thighs flexed, using bimanual palpation during in- 
spiration and expiration. 

In male patients the penis is inspected. With fore- 
skin retracted the foreskin and glans are examined. The 
meatus is viewed for stricture or hypospadias. The 
urethra, from meatus to bulb, is palpated for tumor or 
chancre. 



During the examination of the testis and epididymis, 
one hand steadies the contents of the hemiscrotum 
while the other hand palpates them. Each is palpated 
in turn, noting consistency, size, and position. The epi- 
didymis normally is located posterior to the testis. The 
vas deferens and vessels are identified by pulling the 
testis downward to stretch the cord structures slightly. 
Scrotal masses are transilluminated to distinguish fluid 
which transmits light readily in hydroceles and sper- 
matoceles from solid tumors or inflammatory masses. 

During palpation of inguinal and femoral regions one 
notes particularly the presence or absence of lymphade- 
nopathy, the femoral arterial pulsations, fascial defects 
or protruding hernial sacs. The latter are best detected, 
in adults, while the patient stands. The external ring 
may be palpated accurately with the fingertips in the 
evaginated scrotum. In infants and children indirect 
inguinal hernia sacs may be sensed as thickenings of 
the spermatic cords as they course out of the inguinal 
canals over the pubic crest into the scrotum. Abdomi- 
nal tumors in small children are transilluminated to dis- 
tinguish fluid-filled hydronephroses from other tumors. 

During the rectal examination one must inspect the 
perineum and anus under good light. Generous amounts 
of lubricant on the examining finger dinimish discom- 
fort and the patient is asked to strain down as in defe- 
cation to relax the anal sphincter as the finger is in- 
serted. The tonicity of the anal sphincter and levators, 
presence or absence of lesions of the anal canal and 
intra-rectal or para-rectal pathology are all noted. The 
prostate is examined, by touch, for its size, which is 
about 3 cm across; its contour which is heart-shaped; 
its consistency which is resilient, and whether or not 
the organ is tender, or soft, or contains lumps or 
masses. Normally the gland is slightly moveable up and 
down as it rests upon the urogenital membrane. Fixa- 
tion of the gland is abnormal. In conjunction with the 
prostate the adjacent posterior bladder wall, seminal 
vesicles, and prostatic lymphatics paralleling the vesicles 
should be palpated. Normally they are soft and rather 
vague to the touch but when diseased are often readily 
discernible. 

Prostatic fluid may be collected for microscopy, cul- 
ture or cytologic study by examining the gland while 
the patient is standing and bent forward or in the knee- 
chest position. The gland is stroked firmly with the 
fingertip on alternating sides, from above and laterally 
downward and medially. If fluid does not flow from the 
urethra it may be collected by gentle pressure on the 
bulbous urethra or milked from the urethra by the 
patient. 



Physical Examination of the Surgical Patient. Dunphy, J. E.; and 
Botsford, T. W.: 2nd ed. Phila., W. B. Saunders, 1958 

Demonstrations of Physical Signs in Clinical Surgery. Bailey; 
Hamilton: 9th Ed. Balto. Williams & Wilkins Co. 1944 



U.S. NAVY MEDICAL NEWS LETTER 



EXAMINATION OF THE URINE 

In no patient should routine urinalysis be omitted. 
The container must be clean. Laboratory examination 
must be performed, if accurate results are desired, 
within an hour or two after voiding before bacteria 
begin to proliferate and before formed elements dis- 
integrate. The most dependable results are obtained 
when the responsible examiner does the analysis him- 
self at once. 

If possible, one should take the opportunity to watch 
the patient, whether young or old, while he voids. 
Abnormal straining will become apparent as will slow 
micturition, hesitancy, intermittency, dribbling, dysuria, 
or loss of control. 

If disease of the urethra, prostate or bladder is sus- 
pected in a male, he may be asked to void in two 
glasses after the examiner has inspected the urethral 
meatus for pus or blood. Pus or shreds of exudate or 
blood appearing only in the first glass suggest disease in 
the urethra whereas similar elements in the second or 
both glasses suggest a lesion higher in the urinary 
system. 

If urinary infection is likely much may be learned 
about its character in a short time by examining a drop 
of centrifuged urinary sediment stained by Gram's 
method. 

Cultures are a more sensitive and accurate method 
for ascertaining the presence or absence of infection. 
When technical facilities are available bacterial counts 
should always be performed. Bacterial counts over 
100,000 per ml almost always signify infection. Fewer 
than 1,000 suggest contamination or result from incon- 
sequential urethral flora. Counts in intermediate ranges 
must be evaluated in conjunction with other criteria 



and if at variance with them the cultures should be 
repeated. The results of quantitative cultures are gen- 
erally dependable in male or female patients if the 
genitalia have been cleansed, if the "mid-stream" urine 
has been aseptically collected, and particularly if morn- 
ing specimen is collected. Sterile urine remains sterile 
in the body overnight whereas bacteria, if they are 
present, will proliferate in the bladder while the patient 
sleeps and appear in greater numbers in the morning 
urine. 

Cytological (Papanicolaou) examinations of urinary 
sediment for evidence of malignancy have not been 
dependable for renal or prostatic cancer, but are very 
helpful for diagnosing primary or recurrent carcinoma 
of the bladder. 



Study of Five Hundred Patients with Asymptomatic Hematuria. 

Greene, L. F.; O'Shaughnessy, E. J.; and Hendricks, E. D. : 

JAMA 161: 610-613, June 16, 1956 
Essential Renal Hematuria. MacMahon, H. E.; and Latorrace, R.: 

J Urol 71: 667-676, June 1954 
Cytology of the Prostate Gland in Diagnosis of Cancer. Clarke, 

B. G.; and Bamford, S. B.: JAMA 172: 1750-1753, April 16, 1960 
The Reliability of the Papanicolaou Technique When Cancer Cells 

are Found in the Urine. Roland, S. I.; and Marshall, V. F.: 

Surg, Gyne & Obstet 104: 41-t4, January 1957 



* Doctor Clarke's current address is 1224 Jefferson Bldg., Peoria, 
Illinois 61602. He holds the rank of Commander in the Medical 
Corps of the Ready Reserve, and is engaged in the private prac- 
tice of Urology. He served as a medical officer on active duty 
with the Navy during World War II and the Korean Conflict. 
We are indebted to both authors for this opportunity to republish 
their material. 
** Doctor Harrison holds the rank of Lt. Col. MC AUS, Retired. 
*** Doctors Clarke and Harrison had a thousand copies of this 
publication made and distributed to students and house officers 
at Harvard and Tufts. The supply is now exhausted. Through 
special permission of the authors, it is planned to republish in 
future issues of the Medical News Letter, selected papers from 
this excellent 137-page document. — Editor 



PREVENTION OF MENTAL ILLNESS 

A seminar on public health practice and the preven- 
tion of mental illness was held in London from 6 to 17 
July 1964 by the WHO Regional Office for Europe, in 
co-operation with the Government of the United King- 
dom. It discussed the role of the public health and 
mental health services in the prevention of mental dis- 
orders, with special emphasis on services administered 
and operated by public health personnel, including ma- 
ternal and child health centres, school and university 
health services, and services for the elderly. The theory 
and practice of general preventive measures, including 
the health education of the public with regard to mental 
health and the preventive role of the visiting nurse, were 
also reviewed. 

The participants in the seminar included public health 
administrators, general practitioners, paediatricians, 
public health nurses, and mental health staff. 



TEACHING OF PREVENTIVE MEDICINE 
IN EUROPE 

Progress in the teaching of the preventive aspects of 
medicine in European medical schools over the past 
10-15 years was discussed at a Symposium held from 
22 to 30 July 1964 in Nancy, France, by the WHO 
Regional Office for Europe. The aims and scope of 
such teaching were reviewed, together with ways and 
means of improving it. 

Specific topics included: the teaching of preventive 
medicine in connection with the preclinical and clinical 
sciences, pathology, microbiology, and psychology; the 
place of statistics and epidemiology in such teaching; 
and the role of special chairs of preventive and social 
medicine. 

The Symposium was attended by some 30 partici- 
pants from countries in the European Region, and by 
representatives of several international organizations. 



U.S. NAVY MEDICAL NEWS LETTER 



The Problem of Psychosomatic Diagnosis 

CAPT Charles S. Mullin MC USN*. From the Proceedings of the Monthly Staff 
Conferences of the U.S. Naval Hospital, NNMC, Bethesda, Md. 20014 



This discussion shall be confined to the type of 
psycho-physiological disturbance of somatic function 
which has not yet led to observation of tissue change 
as, for example, in a neurodermatitis or a gastric ulcer 
and, hence, may represent a diagnostic problem: the 
psychogenic headache and backache, dyspepsia, diar- 
rhea, or what not. 

It is indeed a tragedy to mistake the symptoms of 
gastric carcinoma for neurotic dyspepsia, but neither 
is it of benefit to subject a nostalgic recruit to a lapa- 
rotomy when his abdominal pain and vomiting are 
more expressive of a yearning for home and loved 
ones than indicative of some intra-abdominal disorder; 
or to subject the unhappy housewife to a graded series 
of pelvic interventions when her longstanding and medi- 
cally frustrating symptoms are more reflective of do- 
mestic infelicity than of primary GYN disease. 

Nonetheless, it is my thesis that considerably more 
time, energy, and anxiety are expended than is neces- 
sary, by the average medical officer in a search for pri- 
mary organic factors to explain the somatic symptoms 
arising from an emotional disturbance, to arrive safely 
and soundly at the correct diagnosis. The approach to 
diagnosis often seems to be too much of a negative 
process, i.e., if all possible tests and examinations are 
negative, then the condition must be psychogenic. 

It is recommended that more consideration be given 
to the positive approach to the diagnosis of the psycho- 
somatic condition and following are some suggestions 
as to how this may be effected. 

Perhaps one of the most common reasons for de- 
layed diagnosis is that the possibility of emotional de- 
termination is simply not seriously entertained. When 
the physician considers that the symptoms at hand 
may be of an emotional origin it is of value to elicit 
evidence of basic pathological anxiety and/ or depres- 
sion. The average patient complaining of psychogenic 
headache, backache, indigestion, frequency, lower bowel 
disturbance, fatigue, or what not, will show evidence 
of basic anxiety or depression even though he neither 
admits "nervousness" or depression or recognizes that 
he is in fact anxious or depressed. 

Naturally, signs of undue tension should be looked 
for (due consideration being given, of course, to the 
possibility that some degree of autonomic reaction may 
be the result of the examination itself or other extrane- 
ous influences). The tense, nervous manner, the rapid 
beating of the carotid pulse, palings and flushings, di- 
lated pupils, tremor of the hands or voice, hyper- 
hydrosis, cold moist hands, various aberrations of 



* Doctor Mullin is Chief of Neuropsychiatry Service of the USNH, 
NNMC, Bethesda, Md. 



breathing, may serve as examples; sighing, rapid, shal- 
low, or irregular respirations, and aerophagy are of 
course useful findings in this connection. A "pounding" 
quality of the heart beat on auscultation without a 
necessary increase in rate may be of significance. One 
of the more useful indications is palmar sweating. Cold 
sweating palms, especially in the absence of much 
sweating elsewhere, is a fairly certain indication of 
a'nxiousness; the symptom is also found in patients who 
do not choose to acknowledge "nervousness" because 
of their reluctance to have symptoms degraded as men- 
tal in origin or in patients who do not feel any anxiety. 
Sweating of this kind is of particular diagnostic value 
if the patient realizes that the condition has been pres- 
ent since the beginning of the preoccupying complaints. 

In addition to these objective physiological evidences 
of anxiety, it is important to inquire about the presence 
of certain subjective manifestations, one or more of 
which are invariably present in psychosomatic dis- 
orders in addition to the presenting complaints. These 
might include undue consciousness of heart action, 
ready breathlessness, increased frequency of micturition, 
pressure head sensations, postural dizziness, impaired 
concentration, "shakiness" on effort, restless sleep, im- 
paired appetite, morning nausea, or gastric distress. 
Any of these symptoms might be a reflection of organic 
disease, but in psychosomatic diagnosis if none of these 
corollary manifestations are present, in addition to the 
main complaint, some doubt justifiably might be enter- 
tained in the assumption of psychogenesis. The symp- 
toms are especially valuable if they have been noticed 
only since the patient's presenting symptoms have 
troubled him. The point is that such symptoms if 
elicited are often not given due consideration. 

A careful consideration of the special features of 
the presenting symptomatology itself is helpful in ar- 
riving at the correct diagnosis. For purpose of illustra- 
tion this discussion will include symptoms referable to 
the gastrointestinal tract, the cardio-respiratory system, 
and the neuromuscular system. 

Gastrointestinal. Complaints referable to the upper 
GI tract, especially the stomach, are quite common. 
There are some "typical" features of the symptomatic 
picture of the psychologically determined non-ulcerative 
gastric disorder, and this will be described. (It is recog- 
nized, of course, that certain organic diseases can give 
rise to the picture resembling many of the features of 
the symptomatic pattern to be described. Therefore, too 
heavy reliance should not be placed on this one feature 
of the entire picture and any patient over 35 who com- 
plains of chronic dyspeptic symptoms should have a 
thorough radiological survey. However, taken in con- 



U.S. NAVY MEDICAL NEWS LETTER 



junction with other elements of the total picture, a con- 
sideration of the descriptive aspects of the presenting 
complaint is of value.) The pain is diffuse and vaguely 
described. It comes on within an hour after meals. 
Food aggravates rather than alleviates this pain and 
the effect of alkalies is quite variable. There are incon- 
sistencies in the type of food indicated as especially 
irritant. Usually "heavy" fried or greasy foods are 
avoided. Often, preconceived notions (or a condition- 
ing process) are determinant in the patient who can 
digest milk but is unable to take eggs; apples but not 
oranges; bacon but not fried ham; broccoli but not 
spinach. (A case from the Medical Department that 
came to my attention recently becomes dyspeptic only 
when he ingests citrus fruits or bananas.) A fair to 
good appetite prior to sitting down to a meal, followed 
by loss of appetite or even revulsion at the sight of food 
or after a few mouthfuls is characteristic. "Food seems 
to stick on the way down," "lays heavily on the 
stomach," or "it does not seem to digest properly." 
Quivery, tremulous and "nervous" feelings in the stom- 
ach are often described. Recognition of the relation- 
ship between emotional tension and aggravation of 
symptoms is frequently present. Morning nausea is 
very common. Vomiting is also common, usually within 
an hour of taking food, and often relieves the distress 
immediately. 

Aerophagy. A word might be said at this point about 
the affects of aerophagy. As you remember, little Abner 
often gulps nervously when he is in a tight situation. 
The nervous and compulsive swallower accumulates 
large amounts of air in his bowels which may have the 
effect of pushing up against the diaphragm and disturb- 
ing the anatomic physiological relationships within the 
thorax. The situation may be quite misleading and give 
rise to symptoms suggestive of peptic ulcer, gallstones, 
and heart disease, including angina pectoris. 

Cardio-respiratory. These complaints include chest 
pains, palpitations, and breathlessness, alone or on com- 
bination. The pain is usually apical in location. How- 
ever, there is occasional substernal localization but I 
have never heard the pain described as crushing or 
pain referred to the basal region of the cardiac sil- 
houette where I felt this condition was psychogenic. 
The shortness of breath from some sensation of oppres- 
sion through the chest, the feeling of inability to get a 
"satisfying" breath is often associated with frequent and 
sighing respirations as the patient tries to get more air 
and rid himself of the anxious feeling in his chest. The 
shortness of breath is present on slight exertion and 
sometimes, if the symptom is scrutinized closely, it is 
ascertained as the breathlessness begins almost immedi- 
ately with the commencement of the exertional effort 
and indeed seems almost anticipatory. I once observed 
a group of soldiers in a British Hospital during World 
War II, all of whom were suffering from so-called effort 
syndrome, who experienced much less discomfort from 
their symptoms of breathlessness, palpitations, and 



fatigue when they were required to walk up a certain 
small hill backwards than they experienced when they 
had to climb the same hill while facing it! The anxiety 
they experienced was also less. 

Neuromuscular. Aches and pains in various parts of 
the body, especially in the back and extremities are 
frequent complaints. Here the pain typically travels 
from one part of the body to another. Muscles are 
involved more than joints. In the extremity that is cur- 
rently the most troublesome, tremors and increased 
sweating are observed. Examination of the part often 
seems to cause a definite increase in the anxiety inde- 
pendent of pain. Feelings of stiffness, swelling, and 
tightness of the involved part in the absence of any 
objective signs are common. Then there is the familiar 
psychogenic backache. When back pain is complained 
of the patient will usually agree that there is also 
marked weakness of the lower back. Hyperesthesia of 
the skin on the lower back is frequently present. Often 
a mere light stroking of the skin causes the patient to 
flinch or to complain that the sensation is unpleasant. 
Radiation of pain down the back of the legs is rare. 
Radiation of low back pain upward is, I believe, rare 
in organic infections but not uncommon in psychogenic 
backaches. Further I have never heard a patient de- 
scribe a sharp increase in pain on coughing or sneezing 
who did not in all likelihood suffer from an organic 
lesion, whatever the psychogenic elaboration. (I would 
suggest that the typical psychogenic backache represents 
the combined influences of sustained muscular contrac- 
tion, poor posture induced by the impaired morale of 
the neurotic patient or, above all, the factor of atten- 
tional elaboration.) 

In endeavoring to make a psychosomatic diagnosis, 
attention should certainly be directed to the patient's 
personality. Is the patient's personality the type or 
quality that might be related to a susceptibility to neu- 
rotic symptoms? This "predisposition" may be dis- 
cerned in the sphere of behavior or symptomatology. 
Tactful inquiry can be made into the patient's familial, 
social, occupational and marital adjustment and, if the 
occasion is propitious, the sexual adjustment of neurotic 
patients or the majority of patients with psychosomatic 
symptoms will show evidence of some failure of adjust- 
ment in one or more of these areas. Inquiry might 
also be made into the existence of so-called "neurotic" 
traits in the past, for example, frequent nightmares, 
sleepwalking, prolonged thumb sucking, enuresis, etc. 
However, these are not nearly so significant in the past 
history as the existence of suggestive "psychosomatic" 
symptoms. It is well to look for past history of fre- 
quent headaches (often of the "sick" variety) capricious 
appetite, frequent gastric distress, frequent dizzy spells 
and fainting attacks, undue consciousness of heart 
action, tendency to breathlessness, lack of physical 
stamina out of proportion to physical build, ready 
fatigability, susceptibility to frequent colds, tendency to 
backaches and vague rheumatic pain, and certainly 



' 



U.S. NAVY MEDICAL NEWS LETTER 



menstrual difficulties in women. Whenever possible, it 
is useful to evaluate these manifestations in the light of 
the patient's life situation at the time of their occur- 
rence. 

Finally, in endeavoring to establish a psychosomatic 
diagnosis it is helpful to search for causative factors. I 
seldom have complete confidence in my diagnosis unless 
I am able to discern some evidence of plausible psycho- 
dynamics. (There is one exception to which I will 
allude later.) Most psychogenic conditions are the result 
of a variety of subtly interacting factors. But in most 
instances the principal precipitating factors and dynamic 
themes can be discovered if one knows what to look 
for. In very general terms it may be said that any per- 
sisting threat to security or self-esteem or chronic lack 
of emotional satisfaction crucial to the person may give 
rise to anxiety and depression and their diverse symp- 
tomatic and attitudinized elaborations. Such threats or 
lack of emotional satsifaction may be inherent in a 
number of situational patterns. Following are some of 
the more frequent. 

The usual, and quite obvious, domestic, financial, 
marital, sexual and disciplinary troubles. Oddly enough, 
the patient frequently fails to mention these important 
and obvious worries because he does not think they are 
relevant. Hence the possibility of immediate conscious 
problem must always be considered. 

Separation from a milieu of home, family and civilian 
life in which the patient felt secure (including the 
familiar nostalgia of an immature recruit). 

General thwarting of emotional satisfaction, inherent 
in the military setup, in a person of strong dependency 
needs. This type of conflict may be an important part 
of the emotional stress of the factors mentioned above 
but very often exists independently of the mere fact of 
separation from civilian security and support. This is 
a very common type of conflict and it is often more or 
less subtly disguised — perhaps as an overcompensatory 
aggressiveness or air of independence. 

Anxiety related to the arousal of hitherto dormant, 
but potentially powerful, hostile impulses as the result 
of "temperamental" clash with certain aspects of a mili- 
tary organization; perhaps the restriction and regimen- 
tation of the life and the presumed arbitrary discipline, 
or interpersonal difficulties with specific authoritarian 
figures. 

In the case of female dependents, there is a familiar 
problem of rebellion against the burdens of her triple 
role of mother, wife, and housewife. 

Homosexual conflicts, conscious or otherwise, brought 
about by a life of close communal association with 
other men as well as anxiety related to other sexual 
problems. 

Increase pressure of work and responsibility (often 
following promotion) in a basically insecure person. 

As an illustration as to how this approach can 
rule out the psychosomatic condition as well as rule it 
in, I should like to cite a case of mine that gave me a 



certain unseemly satisfaction. This was the case of a 
plebe midshipman and trackman I saw "some time ago. 
For two weeks he had been coming down faithfully to 
sick call with complaints of pain in both lower legs. 
He was told he had "shin splints." He had been placed 
on the excused squad, was temporarily taken off the 
cross-country squad and extensively treated with all the 
facilities available to the medical department accus- 
tomed to treating injured athletes. He had had all 
kinds of physiotherapy including ultrasonic treatment. 
But still he came back day after day complaining of 
no improvement. Finally after hobbling down to one 
particularly crowded sick call his familiar and frustrat- 
ing presence aroused such negative feelings that he 
was told "look plebe, this is either all in your head or 
you're a gold bricker and I'm going to send you to the 
psychiatrist." He shuffled painfully into my office. He 
seemed aggrieved and was obviously having difficulty 
controlling his irritation. However, the more I talked 
with him the less convinced I was that he had a psycho- 
somatic or hysterical condition. First there was no par- 
ticular evidence of pathological or inappropriate anxiety 
or depression. Second, the description of the symptoms 
themselves did not appear particularly suggestive — just 
pain in the lower shins — no symptoms referable to any 
other systems. Third, the previous personality and pre- 
vious life adjustment seemed perfectly satisfactory. 
Fourth, and finally, there seemed to be no particular 
reason why he should have this particular complaint. It 
would be more to his advantage not to have it, as he 
was a good athlete and could get on a training table 
and thus escape much of'the stress of the plebe "indoc- 
trination" program. I had recently come across an 
article about traumatic periostitis and was all primed. 
I took him by hand down to the x-ray department, had 
some plates taken and to my amateur view there ap- 
peared to be some pathology in his lower tibias. This 
was confirmed by the radiologist who made a diagnosis 
of traumatic periostitis. This sort of triumph does not 
occur very often; I cite the case not to crow, but to 
illustrate my points. 

I mentioned above that I am never completely satis- 
fied about my diagnosis of a psychosomatic condition if 
I am unable to discern plausible reasons why the man 
should have the symptoms. There is one exception. A 
severe depression can be concealed by a preoccupying 
complaint of pain in some part of the body. This de- 
pression may have no known psychological origin and 
must be considered "endogenous." Both patient and 
physician become absorbed in endeavoring to track 
down the cause of the pain and miss entirely the exist- 
ence of depression or consider that it is secondary. I 
had an officer patient at this hospital some years ago 
who had been admitted twice to the Medical Service for 
investigation of multiple somatic complaints including 
divers pains and aches. He had accumulated a most 
impressive and weighty chart. Finally, he was sent to 
the psychiatric department and it appeared to me that 



U.S. NAVY MEDICAL NEWS LETTER 



his basic trouble was a severe depression, although 
there seemed to be no obvious psychological reason 
why he should have this condition. He submitted to 
five electro-convulsive therapies. After the second treat- 
ment he was completely free of all symptoms that had 
troubled him for months in the past and asked to be 
permitted to go out and play golf. He was eventually 
returned to duty. 

A final word of caution: While direct and even 
"leading" questions may be necessary to save time, 
one should endeavor to minimize the possibility of 
"suggesting" symptoms to the patient, and, of course, 
one should be sympathetic and respectful of the patient 



as a person and avoid any "third degree" approach 
which could inhibit frank and objective responses. 

To summarize: The identification of a so-called 
"psychosomatic" condition can be greatly expedited, 
with benefit to patient and physician, by placing empha- 
sis more on the positive systematic approach to the 
diagnosis rather than on the customary negative "ruling 
out" process. This is accomplished by being alert to 
the possibility of psychogenic! ty, by looking for evi- 
dence of anxiety, or depression by considering the qual- 
ity of the previous personality, by studying the specific 
features of presenting symptomatology and finally by 
seeking diligently (but not overstrainingly) for plausible 
psychodynamics. 




Miscellany 



MEETING OF THE MILITARY 

GOVERNMENT-CIVIL AFFAIRS 

PUBLIC HEALTH SOCIETY 

The Military Government-Civil Affairs Public Health 
Society will hold its annual meeting in New York City, 
on Wednesday, 7 October 1964, in conjunction with 
the Annual Convention of the American Public Health 
Association. 

The dinner meeting will be at 5:30 p.m. in the War- 
wick Room of the Warwick Hotel, featuring LCOL 
Heyward G. Brown VC USA as the principal speaker, 
who will talk on, "U.S. Army Civic Action in Eritrea, 
1960-1963." The professional program is between 
7:30-9:30 p.m. 

The Society is an organization of professional per- 
sonnel, most of whom have active or reserve military 
status and have served or are currently assigned to a 
military organization in a position involving public 
health responsibilities in relation to civil affairs. This 
is the only association which actively maintains and 
develops a group of professional personnel experienced 
in the public health and medical care functions of civil 
affairs and military government. 

Medical personnel, on active and inactive duty, plan- 
ning to attend the Annual Convention of the APHA 
may be interested in attending the meeting of the So- 
ciety. BuMed funds cannot be provided for this pur- 
pose, — Submitted by Preventive Medicine Div., BuMed. 



ACTIVE DUTY MEDICAL OFFICERS 
IN PRIVATE PRACTICE 

A recent instance has come to the attention of the 
Judge Advocate General of the Navy, wherein an active 
duty medical officer has placed himself in a position of 
jeopardy through the administration of his private 
civilian practice. The policy of the Navy in regard to 
officers in private practice is clearly stated in Article 
3-26A, Manual of the Medical Department, U.S. Navy. 

All active duty medical officers are urged to familiar- 
ize themselves with the contents of the above noted 
article. Those active duty officers who are engaged in 
civilian practice or any type of civilian professional 
affiliation are urged to pay particular attention to para- 
graphs (5) and (7), of that article, which read as 
follows : 

"5. BUMED considers that the authority is in the 
commanding officer of the Medical Corps officer con- 
cerned to determine either that private practice inter- 
feres or does not interfere with the officer's perform- 
ance of duty in the command. Professional liaison 
with local and national medical associations having to 
do with relationship between physicians who have status 
as officers of the Medical Department of the Navy and 
private practitioners is a matter of technical control by 
BUMED. 

"7. A physician in any private medical activity or 
practice who also is an officer of the Medical Corps on 
extended active duty shall not accept a fee, directly or 



10 



U.S. NAVY MEDICAL NEWS LETTER 



indirectly, for care of a member, or dependent of a 
member, of the uniformed services entitled to medical 
care by the uniformed services." — Medical Corps 
Branch, Professional Div., BuMed. 

COMMENDATION FOR ACHIEVEMENT 

LCDR Owed i a Marie Searcy NC USN, received the 
Navy Commendation for Achievement on 21 July 1964 
for outstanding achievement in the superior perform- 
ance of her duties as set forth in the following 
CITATION: 

"During the period 14 September 1963 through 1 
June 1964, while serving as the Anesthetist and Oper- 
ating Room Nurse of the Headquarters Support Activ- 
ity, Station Hospital, Saigon, Republic of Vietnam, 
LCDR Searcy consistently carried out her duties with 
outstanding skill and resourcefulness, contributing di- 
rectly to a progressive increase in this facility's capa- 
bilities and responsiveness in the treatment of combat 
casualties and various other emergency and routine 
treatment. Specifically, she was charged with the re- 
sponsibility for insuring the functional capability of 
an emergency room and operating room in a newly 
remodeled hospital. Through her tenacity, untiring 
efforts and professional ability, these facilities were 
operational in optimum time. LCDR Searcy's leader- 
ship, personal integrity and devotion to duty were in 
keeping with the highest traditions of the naval service." 
S/ Paul H. Nitze 

Secretary of the Navy 

MERITORIOUS MAST AWARDED 
HM 1 ROY L. STRACK USN 

On 17 August 1964 HM 1 Strack appeared before 
A. R. Rieder USMC, Commanding Officer, Marine Air 
Base Squadron 11, Marine Aircraft Group II, 1st Ma- 
rine Aircraft Wing, Aircraft FMF, Pacific, who made 
the following remarks regarding Strack's accomplish- 
ments: 

"You are hereby commended for your performance 
of additional duty as the medical instructor in a Spe- 
cial NCO course held at Marine Air Base Squadron 1 1 
during the period 3-6 August 1964. 

"The manner in which you presented your instruc- 
tions and the professional attitude which you have 
shown are evidence of a high degree of competence 
and devotion to duty. The Marine Corps is especially 
pleased to recognize outstanding performance of duty 
by members of the U.S. Navy serving with us. 

"In accordance with (the provisions of) the Marine 
Corps Personnel Manual, a copy of this letter will be 
forwarded to your Officer-in-Charge for inclusion with 
your next fitness report." 



ADMIRAL KREUZ TO HOST NAVY PARTY 
DURING ACS MEETING 

During the American College of Surgeons meeting 
in Chicago, an "All Navy" social party, with refresh- 
ments, will be sponsored by RADM Frank P. Kreuz 
MC USN, on Wednesday, 7 October 1964, from 6:00- 
8:00 p.m. at the University Club, 76 Monroe Street, 
Chicago. Admiral Kreuz is Commanding Officer of the 
U.S. Naval Hospital, Great Lakes, Illinois, and DMO, 
NiNTH Naval District. 

Naval Officers past and present, and their ladies are 
cordially invited to attend. Subscription is $5.00 per 
person. Forward checks and reservations to CAPT 
Philip O. Geib MC USN, Chief of Surgery at the Naval 
Hospital, Great Lakes, Illinois. 



Urgent Training Notice 

APPLICATIONS FOR INSERVICE 
RESIDENCY TRAINING 1965-1966 

Interested applicants for inservice residency training, 
should carefully review BUMEDINST. 1520. 10B for 
information concerning programs offered and proce- 
dure for submitting applications. 

Deadline for submission for inservice training pro- 
grams to begin in the summer of 1965 is 15 November 
1964. Candidates will be notified of selection or non- 
selection by 15 December 1964. Applications, sub- 
mitted via chain of command, should be for the full 
training program as outlined in BUMEDINST. 1520. 
10B. 

Combined programs, such as in Neurosurgery, 
should be requested for the inservice portion first to 
begin in the summer of 1965, with the civilian portion 
to follow in a civilian institution to be determined. 

Applicants are encouraged to list at least three 
choices of naval hospitals for location of training if 
such choices exist in the chosen specialty, and may feel 
free to write the chiefs of services for details for the 
training offered, if desired. 

Early submission of applications is recommended to 
assure processing through chain of command and re- 
ceipt in BuMed prior to the 15 November 1964 dead- 
line. — Training Branch, Professional Div., BuMed. 

OAK KNOLL PROVIDES PEDIATRIC 

TRAINING PROGRAM FOR CIVILIAN 

NURSING STUDENTS 

CDR Delmer J. Pascoe, Chief of Pediatrics at U.S. 

Naval Hospital, Oakland, addressed Oakland City Col- 
lege nursing students at their recent graduation. "The 
Challenge of Nursing Today" was his subject. 

Under Doctor Pascoe's leadership and that of former 
Oak Knoll Chief Nurse, CDR Ruth M. Cohen, Oak 



U.S. NAVY MEDICAL NEWS LETTER 



11 



Knoll provided practical experience in pediatric nurs- 
ing for the Oakland City College nursing students dur- 
ing the past year. The young ladies, coming in small 
groups, worked on the ward and in the Pediatric Clinic, 
where they gained knowledge of procedures required 
for office nursing. 

The affiliation will continue during the coming year 
under the guidance of CDR Veronica Bulshefski, Chief 
Nurse; Mrs. Margaret Gingrich, Chairman of the De- 
partment of Professional Nursing at the college; and 
Doctor Pascoe. — Submitted by RADM Cecil L. An- 
drews MC USN, Commanding Officer, USNH, Oak- 
land, California. 

NEW CERTIFICATION PROGRAM FOR 
BIOLOGICAL PHOTOGRAPHERS 

A certification program for biological photographers 
— under development for 15 years — was launched on 
24 August 1964, by the Biological Photographic Asso- 
ciation. The Association is beginning its 34th annual 
meeting at the Roosevelt Hotel in New York. 

Approximately 900 intensive users of photography 
as a scientific tool in biology, medicine and agriculture 
are members of the Biological Photographic Associa- 
tion. The certification program announced today is 
designed to set meaningful criteria for judging profes- 
sional competence and for planning educational and 
scientific institutions seeking capable specialists and to 
photographers and scientists seeking to advance their 
competence. 

A series of practical, written and oral examinations 
will be conducted for applicants meeting educational 
and experience qualifications. Examinations will cover 
photographic technology and subject matter in the 
sciences selected for specialization. 

Consultants to the BPA Education and Certification 



Committee include representatives of American Asso- 
ciation of Dental Schools, American Dental Associa- 
tion, American College of Hospital Administrators, 
American College of Surgeons, American Hospital As- 
sociation, American Institute of Biological Science, 
American Medical Association, American Veterinary 
Medical Association. 

Detailed information on the certification program of 
the Biological Photographic Association can be ob- 
tained from certification committee chairman Howard 
Tribe, Chief of the Medical Illustration Service, Uni- 
versity of Utah College of Medicine, Salt Lake City. 

SAFETY MESSAGE 

By Courtesy of the State Police and the Department of 
Health and Welfare, Bureau of Health, State of Maine. 

Many and sharp the numerous ills inwoven with our 

frame: 

More pointed still, we make ourselves Regret, Remorse, 

and Shame, 

And man, whose heaven-erected face, the smiles of love 

adorn — 

Man's inhumanity to man makes countless thousands 

mourn. 

"These classic lines were written by the immortal 
Scottish poet, Robert Burns, before the days of auto- 
mobiles, but they are timeless. On foot, in a horse- 
drawn vehicle, or on a superhighway, the principle is 
the same. "Without consideration for the other fellow 
as another human being, tragedy and heartbreak fol- 
low." (Quoted from Dr. Will B. Campbell, Former 
President, Kentucky Wesleyan College.) 

NOTE: The State Police of Maine implore people to 
read this article and to drive by "The Golden Rule." 

— Editor 



HEAT ILLNESS 

In 1962 WHO convened a Conference on Medicine and Public Health in the Arctic and Antarctic, at which 
the problems of cold were discussed at length. Although problems of heat are incomparably more important, 
since an immeasurably greater number of people live in hot countries and most of WHO's work is concerned 
with them, no conference dealing specifically with these problems has yet been convened, no doubt because so 
many of them are subsumed under WHO's multifarious activities in tropical countries. In 1960, however, on 
the proposal of the representative of Saudi Arabia at the tenth session of the WHO Regional Committee for the 
Eastern Mediterranean, the subject "Solar radiation and its related heat effect on the human organism" was 
chosen for the technical discussions to be held at the twelfth session in 1962. In preparation for the discussions, 
a WHO advisory mission attended the 1961 Mecca Pilgrimage at the invitation of the Saudi Arabian Govern- 
ment. 

The first of these two articles on heat illness was prepared by Dr. A. W. El Halawani, WHO Deputy Re- 
gional Director for the Eastern Mediterranean, who was a member of the mission. The second, by Dr. C. S. 
Leithead, Lecturer in Tropical Medicine, Liverpool School of Tropical Medicine, who contributed a paper to the 
technical' discussions and who is co-author of a recent book on the subject, places heat illnesses in their back- 
ground and shows how much remains to be learned about them. The WHO Regional Committee for the East- 
em Mediterranean, after a debate on the report of the technical discussions, recommended that heat illness should 
be regarded as an important public health problem and included in WHO's research programme. 



12 



U.S. NAVY MEDICAL NEWS LETTER 



From the Note Book 



Program of "Third Annual Federal Services Pharma- 
ceutical Seminar, 23 October 1964— Officers Club, 
Balling APB, Washington, D. C. 

8:30 a.m. Registration Officers Club 

9:00 a.m. Morning Session Officers Club 

Presiding: John M. Gooch, Chairman, Military 
Pharmacy Section 

1. Opening Remarks and Introduction of Visiting 
Dignitaries — John M. Gooch 

2. Bio-degradable Detergents — Leon W. Weinberger, 
Sc.D., Chief. Basic and Applied Sciences 
Branch, Division of Water Supply and Pollution 
Control, U.S. Public Health Service, Department 
of Health, Education, and Welfare, Washington, 
DC. 

3. Botulism, Current Status and Need for the Tox- 
oid— Paul J. Kadull MD, Chief, Medical Investi- 
gation Division, U.S. Army Biological Labora- 
tories, Ft. Detrick, Md. 

12:15 p.m. Luncheon Officers Club 

Presiding: CAPT Leroy Werley, Jr., Consultant in 
Pharmacy, USAF, MC, Office of the Surgeon 
General, Department of the Air Force, Washing- 
ton, D. C. 
Luncheon Speaker — Major General R. L. Bobannon, 
USAF, MC, Surgeon General, USAF, Washington, 
D. C. 
2:00 p.m. Afternoon Session Officers Club 

Presiding: Lt Col Melvin Crotty, U.S. Army, Vice 
Chairman, Military Pharmacy Section 

1. Adverse Drug Reacting Reporting System and 
Drug Recall Program from IPAD Point of View 
—Rear Admiral C. A. Blick USN, Executive 
Director, Procurement and Production, Head- 
quarters Defense Supply Agency, Cameron Sta- 
tion, Alexandria, Virginia— Chairman; Intra- 
Governmental Procurement Advisory Council on 
Drugs. 

2. Medication Errors in the Pharmacy — Leo God- 
ley, Chief Pharmacist, Harris Hospital, Ft. 
Worth, Texas 

3. Medical and Legal Responsibilities on Blood 
Banking Groups— Paul D. Canton MD, Bethesda, 
Md. 

4. Closing Remarks — Lt Col Melvin W. Crotty, 
U.S. Army 

NOTE: Those interested in attending should contact 
the Program Chairman, CAPT Claude V. Timberlake, 
Jr. MSC USN, Bureau of Medicine and Surgery (Code 
43), Navy Department, Washington, D. C. 203 90, Tel: 
OXford 62523. For this meeting, there are no fees 
or costs involved including the luncheon. 



NEW RESIDENCY PROGRAM 
IN THORACIC SURGERY 

The Bureau of Medicine and Surgery is pleased to 
announce the establishment of an approved two-year 
residency training program in Thoracic Surgery at the 
U.S. Naval Hospital, NNMC, Bethesda, Md. Initially 
it is anticipated that one first-year resident will enter 
the program. 

The program will be in addition to the existing resi- 
dencies in this specialty at San Diego and St. Albans. 

Interested applicants should forward official requests 
to the Chief, Bureau of Medicine and Surgery, Depart- 
ment of the Navy, Washington, D. C. 20390, as out- 
lined in BUMEDINST. 1520. 10B, prior to the 15 
November 1964 deadline for receipt of applications. 
Application may be made only for the Bethesda pro- 
gram, or preferably should list the three hospitals in 
order of preference. — Training Branch, Professional 
Div., BuMed, 

AMERICAN COLLEGE OF SURGEONS 
ANNUAL MEETING 

This Annual Meeting will be held in Chicago, Illi- 
nois, on 5 through 9 October 1964. A special airlift, 
departing Andrews Air Force Base, Washington, D. C, 
is being tentatively scheduled to accommodate medical 
officers of the Armed Forces who desire to attend this 
meeting. 

Interested medical officers should forward requests 
by message for reservations immediately to: Director, 
Professional Division, BuMed. 

USNRDL SCIENTIST TO ATTEND BONE 

MARROW CONFERENCE AS GUEST 

OF FRENCH GOVERNMENT 

Mr. Leonard J. Cole, Head of the Experimental 
Pathology Branch at the U.S. Naval Radiological De- 
fense Laboratory in San Francisco, will participate as 
an invited speaker at the International Colloquium on 
Bone Marrow Transplantation in Paris, 7-9 September. 
His entire trip to Paris is being financed by the French 
National Center of Scientific Research. 

Mr. Cole will report on "Conditioning of Bone Mar- 
row Recipients by Means of Radiation Plus Chemo- 
therapy.'' Human studies, particularly in connection 
with problems of treatment of leukemia by high doses 
of irradiation and bone marrow transplants, will be in- 
cluded in the 34 papers scheduled for the Colloquium. 



U.S. NAVY MEDICAL NEWS LETTER 



13 




Dental Section 



DIFFERENTIATION OF SUBMAXILLARY 
LYMPHADENOPATHY AND SUB- 
MAXILLARY SALIVARY 
GLAND PATHOLOGY 

Louis Mandel, DDS and Harold Baurmash, DDS, 

School of Dental and Oral Surgery, Columbia Univ. 

Oral Surg., Oral Med., and Oral Path. 15(1): 3-14, 
January 1962. 

Due to the proximity of the submaxillary lymph 
nodes and the submaxillary salivary glands, confusion 
in differential diagnosis sometimes arises. The sub- 
maxillary nodes may become involved in such patho- 
logic processes as dental infections, Vincent's and her- 
petic stomatitis, infectious mononucleosis, lymphomas, 
leukemias, and metastasizing neoplastic processes. 
Swelling of the submaxillary gland may be associated 
with sialolithiasis, acute and chronic sialadenitis, some 
viral diseases, Sjogren's syndrome, cystic and neoplas- 
tic conditions. 

In establishing a diagnosis, history and physical 
examination are very important. Consider such in- 
formation as the patient's general state of health, 
weight loss, blood picture, previous related swellings 
or inflammations, fluctuations in swelling size and their 
relation to eating, and associated mucous membranes 
or dental problems. Is there lymphadenopathy in other 
areas? Note tenderness, fluctuation, fixation and firm- 
ness of all positive lymph nodes. 

The extraoral clinical examination should not be con- 
fined to the submaxillary area. The presence of posi- 
tive nodes in the submental and cervical areas helps 
to differentiate lymphadenopathy from salivary gland 
disease. Observe the presence or absence of enlarge- 
ment of other lymph nodes or of other salivary glands. 
Anatomically, submaxillary lymph node swelling is 
usually located more anteriorly in the submaxillary 
triangle. Palpation may reveal the nodes to be more 
superficial than the salivary gland. 

Intraoral examination may determine presence or 
absence of dental infection and sequelae. Check the 
oral membranes and dental soft tissues for infection 
or irritating foci. Palpate the floor of the mouth to 
note tenderness, induration, ulceration and adherence 
to surrounding tissues. Observe the quantity and qual- 
ity of saliva. Early drainage of pus through the ductal 
system resulting in a milky salivary flow would indicate 
acute infection of the salivary gland. With chronic 
sialadenitis the saliva would have a more fiocculent or 



turbid appearance. Quantitative decrease in saliva 
could indicate parenchymal destruction or obstructive 
interference. 

The roentgenographic examination should include 
occlusal films as a survey for calcified material and 
provides a profile of the lingual and labial cortical 
bone. Intraoral periapical films will show presence or 
absence of dental diseases. Extraoral films may show 
calcified lymph nodes, sialoliths, or radiolucent areas. 

Sialography shows the pattern of ductal arborization. 
It is altered in pathology of the salivary gland but is 
usually normal in ductal configuration with lymphad- 
enopathy. The authors then give six case reports with 
the means used in establishing the differential diagnosis. 
(Submitted by CAPT Clyde R. Parks DC, USN, Naval 
Dental School, National Naval Medical Center, Be- 
thesda, Maryland.) 

A REVIEW OF THE PROBLEMS AND 

RESULTS OF STUDIES ON MANUAL 

AND POWER TOOTHBRUSHES 

Major M. Ash, Jr. DDS MS, University of Michigan 
School of Dentistry, Jour Periodontics, 35(3): 202-213, 
May-June 1964. 

Although power toothbrushes are not particularly 
recent in origin, advanced designs, intensive promotion, 
and widespread use of many types and manufacture 
have stimulated considerable interest and research into 
their safety and effectiveness. There are over seventy- 
five electric toothbrushes being marketed today; how- 
ever, at the present time published reports of their 
safety and/or effectiveness have been limited (with few 
exceptions) to only two electric toothbrushes. 

PROBLEMS OF EVALUATING TOOTHBRUSHES 

There are no universally accepted criteria or methods 
for evaluating the effectiveness of a toothbrush. The 
absence of a common method is apparent in the ap- 
proximately forty reports presented in the literature 
on the effectiveness of electric brushes. The reports 
not only show considerable variation in methods, but 
also in the criteria used for evaluating effectiveness. 
Some earlier as well as later studies are almost entirely 
subjective; some are case reports and preliminary re- 
ports; others are restricted studies that do not use, or 
at least report, standardized or statistically useable cri- 
teria; and still others include only a limited number 
of patients. In some studies the criteria for effective- 



14 



U.S. NAVY MEDICAL NEWS LETTER 



ness have been patients' statements that electric brushes 
were better than a regular brush, the teeth felt cleaner, 
or that electric brushes were easier to use than regular 
brushes. Other observations such as "less gingivitis," 
"less plaque," or "less bleeding," in five out of six 
patients using an electric brush can hardly be con- 
sidered to be acceptable criteria of the effectiveness 
of a toothbrush. In some of the most recent studies 
better controls and criteria than previously used have 
been introduced. 

Considering all the problems of equating types of 
bristles, methods of brushing, other variables, and the 
limited number of specific studies on the subject, the 
electric brush appears to be no more injurious to the 
soft tissues than a hand toothbrush, 

SUMMARY 

On the basis of the published reports reviewed and 
our own studies, it cannot be concluded that electric 
toothbrushes are any more effective than manual 
brushes for the average patient. It is recognized that 
one type of brush, electric or manual, may be more 
effective for one individual than another. Also one 
method of brushing may be more effective in one indi- 
vidual than another. 

Because of conflicting reports and the limited num- 
ber of studies on certain types of patients, there is no 
conclusive evidence to show that electric toothbrushes 
are more effective than manual brushes for a specific 
type of patient. It is possible that additional objective 
studies may specifically show that an electric brush 
may be used by a nurse or relative more effectively 
than a manual brush in the care of handicapped indi- 
viduals. 

Because of the absence of truly long term studies in 
which all factors responsible for periodontal disease are 
reasonably controlled or evaluated, it is impossible to 
evaluate the absolute effectiveness of any toothbrush. 
On the basis of our present state of knowledge, it is 
doubtful that any toothbrush now marketed should be 
considered as a therapeutic device. Most toothbrushes 
have some therapeutic effect if used correctly. To sug- 
gest that any toothbrush alone can treat or prevent 
disease effectively is not rational. However, it is ra- 
tional to believe that a toothbrush, electric or manual, 
has a very important part in the maintenance of good 
oral hygiene when related to regular professional dental 
care and education of the patient in brushing are far 
more important than any specific toothbrush. {Sub- 
mitted by CDR Perry C. Alexander, DC USN, U.S. 
Naval Dental Clinic, Long Beach, California.) 

ADULTS MAY GAIN MORE FROM 
FLUORIDATION THAN CHILDREN 

Dr. Frederick J. Stare MD, speaking at the 15th 
National Dental Health Conference sponsored by the 
American Dental Association, said: "Recent studies 



have shown clearly that the administration of sodium 
fluoride in large amounts to adults, amounts varying 
from 20 to 150 mg. per day over periods of several 
months, is most effective in the treatment of osteo- 
porosis and in some cases of Paget's Disease, 

"There are indications that optimum ingestion of 
fluoride throughout life may be helpful in the preven- 
tion of osteoporosis, certainly a common disorder of 
our older citizens. Fewer fractures, and quicker and 
stronger healing when they do occur, would indeed be 
a boon to persons of advancing years. Optimal intake 
of the mineral nutrient fluoride throughout life may 
help to achieve this goal." 

Dr. Stare linked the opposition to fluoridation to per- 
sons in the food faddist field and to quackery in gen- 
eral. 

"There is more sense on nutrition than nonsense, 
though one might well wonder if this is so with all 
the nonsense one hears and reads these days about 
calories not counting, the therapeutic benefits of honey 
and vinegar, the 'poison' some 'misguided' individuals 
want to compel us to add to our water, the wonders 
of 'natural foods' and those fertilized organically, and 
of course, the nutritional nonsense over the radio and 
TV from people with no professional training in nutri- 
tion or any other area of health. 

"Actually calories do count; honey and vinegar do 
not have any unusual therapeutic effects, nor for that 
matter does most of the other 'stuff' available in health 
food stores including 'natural foods' and organically 
fertilized foods; and fluoride is a mineral nutrient, not 
a poison." 

Dr. Stare, who is chairman of the department of 
nutrition at Harvard School of Public Health, said 
there are strong psychological aspects to the public's 
susceptibility to quackery. 

"Fear is a basic cause of vulnerability to quackery. 
Fear concerning illness, physical or mental incapacita- 
tion, weakness, and death returns us to the childish 
condition of wanting reassurance and strength from 
an uncritical adult who promises safety and well-being. 
Then is when the quack steps in and takes over. 

"Much of modern dental and medical practice is un- 
fortunately characterized by a brief, impersonal rela- 
tionship between doctor and patient. We see much 
pain, disease, and suffering, all of it in detail and with 
unavoidable comparison to many similar cases. Hence, 
a patient's particular complaint is put in its proper 
perspective as to its severity and need of treatment. 
Perhaps too often, the proper prescription is something 
so unimpressive as a 'couple of aspirin.' But this is 
not enough to satisfy an individual who considers his 
complaints severe and deserving of sympathy and seri- 
ous treatment. So he turns to the advertisement which 
seems to understand his pain, his need for a new and 
simple treatment. This is when the quack steps in to 
offer his sympathy, packaged as cleverly as the nostrum 
he sells. 



U.S. NAVY MEDICAL NEWS LETTER 



15 



"There are those who turn to quackery 'in ex- 
tremis'; intelligent, well-educated people who have in- 
curable disease who seize upon any promise of hope. 
And hope is what the quack offers in abundance. These 
victims are easily gulled by the quick, easy, and abso- 
lute relief the quack offers. 

"Debunking of quackery's false and extravagant 
claims is a challenge to all in the health profession," 
Dr. Stare said, — Dental Division. BUMED 



a mean difference of 0.46, the equivalent of a 55 per- 
cent reduction in periodontal disease. For Company B 
the mean periodontal scores were 0.94 and 0.89, or 
a mean difference of 5 percent. For Company C the 
mean scores were 0.96 and 1.13. The differences in 
mean scores between the three companies were statisti- 
cally significant. 

The relation between oral hygiene and periodontal 
disease is close. 



DETECTING CONTAMINATION IN 
DENTAL MERCURY* 

Council on Dental Research. American Dental Asso- 
ciation, 222 East Superior Street, Chicago 11, 111. 
J AD A 68: 287. February 1964. From Dental Abstracts 
9(4): 230, April 1964. 

The appearance of the surface of mercury indicates 
its freedom from many kinds of contaminants, and 
provides a useful, simple screening test of its suitability 
for clinical use. 

Under certain conditions even mercury that com- 
plies with ADA Specification No. 6 for Dental Mercury 
may develop a scum. If scum is observed on the sur- 
face of mercury, the mercury should be filtered through 
a chamois skin or amalgam squeeze cloth. If after 
standing for 24 hours the filtered mercury does not 
have a mirrorlike surface the mercury should not be 
used for dental amalgam. Dentists suspicious of the 
purity of a dental mercury may forward an unopened 
bottle for examination to the ADA Research Division, 
National Bureau of Standards, Washington, D. C. 
20234. 

EFFECT OF PROPHYLAXIS AND DENTAL 

HEALTH EDUCATION ON 

PERIODONTAL STATUS* 

Fay, Hsiao-dsung. Department of Dentistry, National 
Defense Medical Center, Taipei, Taiwan. Chinese M. J. 
10: 243-247, September 1963. From Dental Abstracts 
9(4): 248-249, April 1964. 

Oral prophylaxis and dental health education to- 
gether are effective in preventing or decreasing the 
prevalence of periodontal disease, but dental health 
education alone is not. This study involved Chinese 
soldiers, 20 to 45 years of age, from three companies 
selected at random from a Chinese infantry division. 
The men in Company A received both oral prophy- 
laxis and dental health education in the form of lec- 
tures, demonstrations and discussion. The men in Com- 
pany B received only two hours of dental health edu- 
cation, and those in Company C served as a control 
group. 

Four months later all subjects were re-examined. 
For Company A the mean periodontal scores at the 
first and second examinations were 0.84 and 0.38, or 



MANUAL TOOTHBRUSH NOT OBSOLETE* 

Council on Dental Therapeutics. American Dental As- 
sociation, 222 East Superior Street, Chicago 11, 111. 
JADA 68: 279, February 1964. From Dental Abstracts 
9(4): 257, April 1964. 

Any claim that the manually operated toothbrush is 
obsolete is exaggerated, misleading and contrary to the 
public interest. 

Data from some studies emphasize the ability of 
persons to maintain good oral hygiene with a conven- 
tional toothbrush if the persons possess reasonable dex- 
terity and know how to use the brush. 

Although the Council on Dental Therapeutics has 
not yet established its program for evaluation of pow- 
ered toothbrushes, it has informally recognized that 
certain electrically powered toothbrushes are safe and 
effective devices for cleaning the teeth. 

The Council's further evaluation of electric tooth- 
brushes should assist the dentist in deciding what type 
of brush will best serve the needs of individual patients. 
Each electric toothbrush must be evaluated individually. 

IS STOPPING THE SALE OF SOFT DRINKS 
AND CANDY IN SCHOOLS 

THE ANSWER?* 

Millican, Carlene. New York State Department of 
Health, Rochester, N. Y. Are Candy Sales in Schools 
Justified. Jour of Health, Phys. Ed. & Recreation. 
35(35): 65-67, January 1964. From Dental Abstracts 
9(4): 260, April 1964. 

Although the American Dental Association, the 
American Dietetic Association and the Council on 
Foods and Nutrition of the American Medical Asso- 
ciation have all urged that candy and carbonated bev- 
erages not be sold on school premises, a close look at 
the child consumer of today and his environment sug- 
gests that banning such sales in schools may not bring 
about the desired results. 

Vending machine sales have increased from $600 
million in 1946 to $2,586 million in I960. One effect 
of the ubiquitous vending machine is to encourage 
piecemeal eating. Coffee breaks and snacks have be- 
come part of the life of today. With the aid of the 



* These articles are copyrighted by the American Dental Association. 
Reprinted by permission. 



ie 



U.S. NAVY MEDICAL NEWS LETTER 



refrigerator, the vending machine and other gadgets 
we are becoming like the simpler, less organized socie- 
ties in this custom of frequent, unplanned eating. 

Children are growing up in a new tradition. The 
family doesn't just stop for gas — it stops for gas and 
pop. A person doesn't just bowl or skate — he skates 
and eats a hot dog. People now eat and drink when 
they attend sports events, the theater, concerts, and at 
home while being entertained by television. People eat 
and shop in all sorts of stores, even while doing the 
wash at the corner laundromat. 

One sure way of eliminating sweets from the diets 
of children would be to control the source, but how 
can nutritionists and health educators take on the soft 
drink, confectionery and baking industries and the ad- 
vertising business? Banning the sale of candy in schools 
would contribute in some degree toward a reduction 
in caries, but its overall effectiveness is questionable. 
The alternative is to teach the individual child to make 
the necessary choice. Children must learn to under- 
stand and deal with the many inducements to buy food 
and drink. Today children are exposed and conditioned 
to a preference for candy and concentrated sweets long 
before they enter school. Whether or not schools sell 
candy, many children will have it. If children are 
educated in the essentials of nutrition they will be able 
to make wise choices in their selection of food. 

Every child has the right to know what to eat and 
why, and how it affects his health. Nutrition education 
should be a planned part of the total school health 
program. Schools as well as parents share a major 
responsibility for fitting the child for society and 
helping him to be responsible for himself and his 
health. The extent to which both parents and the 
school recognize the importance of nutrition and den- 
tal health education in equipping the child for society 
is the critical issue. When this issue can be resolved, 
the question as to whether candy sales in schools are 
justified becomes unimportant. 

PERSONNEL AND PROFESSIONAL NOTES 

U.S. Navy Dental Corps Continuing Education Pro- 
gram. The U.S. Naval Dental School, Bethesda, Mary- 
land, continues the series of short postgraduate courses 
for fiscal year 1965 with "Preventive Dentistry," 19-23 
October 1964, and "Endodontics," on 26-30 October 
1964. 

The course director in "Preventive Dentistry" is 
CAPT G. H. Rovelstad DC USN. The various aspects 
of prevention and early control of dental disease will 
be emphasized. Attention will be focused on the meth- 
ods of preventing one of the most prevalent of these 
diseases, dental caries. The causes, pathology, and in- 
cidence of the disease, as well as practical methods 
for its control and prevention are presented. 

The course director in "Endodontics" is CAPT J. F, 
Bucher DC USN. This course consists of lectures, 



seminars, and clinical demonstrations of endodontic 
procedures that may be undertaken at any activity. 
Attention is given to the etiology, diagnosis, and treat- 
ment of pulp and periapical pathosis, surgical and non- 
surgical management of periapical problems, and man- 
agement of situations related to other fields of clinical 
dentistry. 

These short courses were established to keep career 
dental officers of the Armed Forces abreast of current 
developments in dentistry, in order that they might 
provide a higher quality of dentistry. Applications 
should be submitted via district and staff dental officers 
and should be received in the Bureau as early as possi- 
ble and, preferably, not less than four weeks prior to 
commencement of the course. Quotas have been as- 
signed to COMONE, COMTHREE, COMFOUR, 
COMF1VE, COMSIX, COMNINE , PRNC, SRNC, 
and CNATRA. Staff dental officers not utilizing as- 
signed quotas should report this information to BuMed, 
Code 611, one month prior to the convening date of 
the course. This will allow the Bureau to fill the quota 
from other districts. 

Caries Prevention Treatment. It is a matter of great 
concern to the Chief of the Dental Division that in 
qurarterly reports, the DD 477, the number of caries 
prevention procedures on line 42 does not closely 
approximate the number of prophylaxes on line 40. 
BY THIS TIME IT SHOULD BE APPARENT TO 
ALL DENTAL OFFICERS that most prophylaxes ac- 
complished in the Navy should be made with the 
stannous fluoride special pumice mixture, followed by 
a topical application of stannous fluoride to all teeth 
present. The patient should then be encouraged to use 
a stannous fluoride dentifrice. Evidence is becoming 
overwhelming that this will materially cut the work 
load of the Dental Corps. 

This three-agent stannous fluoride treatment should 
be accomplished in one sitting; and each such treatment 
should be recorded on both lines 42 and 40. 

It is recognized that, in some cases, in the profes- 
sional judgment of the dental officer, other caries 
prevention treatments will be indicated. All such pro- 
cedures may be recorded on line 42 — MISCELLANE- 
OUS. 

Naval Dental Officer Guest Speaker at the First Bi- 
Regional Conference of State and Territorial Dental 
Directors. CDR George H. Green, DC USN, Head, 
Oral Pathology Division, U.S. Naval Dental School, 
National Naval Medical Center, Bethesda, Maryland, 
recently participated in a dental public health confer- 
ence which included the State Dental Directors of 
Texas, New Mexico, Mississippi, Tennessee, Arkansas, 
Alabama, Georgia, Louisiana, Oklahoma, and South 
Carolina, and Florida's Regional Supervisor. At the 
meeting which was held in Sante Fe, New Mexico on 
14-17 July 1964, CDR Green presented a paper on 
the development of a new and practical diagnostic test 



U.S. NAVY MEDICAL NEWS LETTER 



17 



for the detection of dental caries activity. He also dis- 
cussed the use of the new "Caries Activity Test" as 
the basis for a practical program for the prevention 
and control of dental caries and participated in the 
round table discussions on Oral Exfoliative Cytology, 
Dental Health Guides for Teachers, In-Service Train- 
ing for Staff and Other Public Health Personnel, and 
dentistry for the Chronically 111 and Aged. 

Others taking part in the conference included the 
Honorable Jack Campbell, Governor, State of New 
Mexico; Ralph S. Lloyd, DDS, Assistant Surgeon Gen- 
eral, Chief Dental Officer, U.S. Public Health Service; 
Quentin M. Smith, DDS, Associate Chief, Division of 
Dental Public Health and Resources, U.S. Public 
Health Service; Paul H. Keyes, DDS, Dental Director, 
Laboratory of Histology and Pathology, National Insti- 
tute of Dental Research, U.S. Public Health Service, 
and the Regional Dental Consultants, U.S. Public 
Health Service. 

New Training Courses Made Available to Naval Re- 
serve Dental Officers, Selected short courses at the 
Naval Dental School previously available only to active 
duty officers have been made available as training duty 
for naval reserve dental officers. The two training 
periods will convene on 19 October 1964, and 8 Febru- 
ary 1965, at the U.S. Naval Dental School, National 
Naval Medical Center, Bethesda, Maryland. 

The 19 October period will cover Preventive Dentis- 
try the first week and Endodontia the second week. 
For the 8 February 1965 period, reserve dental officers 
may request either Complete Dentures or Oral Path- 
ology the first week (indicate first choice). The second 
week, all reservists will attend a course on Occlusion. 
Requests by reserve officers for training are made to 
respective commandants. 

Coincidental with availability of these training 
courses, the Dental Military Medicine course as author- 
ized by BUPERS1NST 1571.4 (series) has been dis- 
continued. 

Navy Dentist Heads Armed Forces Dental Group. 
CAPT F. I. Gonzales Jr., DC USN, the Senior Dental 
Officer of the Dental Department, NAS, Alameda was 
recently elected President of the Bay Area Armed 
Forces Dental Study Group for the ensuing year. The 
group is composed of dental officers of all the military 
services in the San Francisco Bay Area. Its purposes 
are to promote greater understanding between dental 
departments of the various services and to improve 



the professional knowledge of the group by scheduling 
guest clinicians. The larger activities of all services 
act as hosts and are responsible for the meetings by 
rotation. Besides CAPT Gonzales, the following offi- 
cers were also elected: CAPT C. E. Johnson DC 
USPHS, Vice President; and LT COL Arthur L. Mil- 
bourn DC USAF, Secretary. 

Naval Dental School Sends Thirty-Eight Dental Tech- 
nicians to the Fleet. CAPT A. R. Frechette, DC USN, 
Commanding Officer, U.S. Naval Dental School, Na- 
tional Naval Medical Center, Bethesda, Maryland, as- 
sisted by CAPT R. R. Troxell, DC USN, Head, En- 
listed Education Department, presented certificates of 
training to thirty-eight dental technicians at formal 
graduation exercises on 19 June 1964. Letters of com- 
mendation also were awarded to those with the highest 
grade averages of the three schools: F. J. Carriger Jr. 
DT2, Advanced General class of nineteen; F. C. Brown 
DT2, Advanced Prosthetics class of ten; K. S. Ander- 
son DT2, Basic Repair class of nine. John C. Peterson 
DT2, received the ninth Thomas Andrew Christensen 
Award in recognition of his loyalty and devotion to 
duty. The award perpetuates the heroism of a Navy 
dentalman during the Korean War. CAPT J. V. Niira- 
nen DC USN, Staff Dental Officer, Headquarters, 
U. S. Marine Corps delivered the graduation address 
entitled "Dental Support of the U. S. Marine Corps." 

MALARIA CARD FOR INTERNATIONAL 
TRAVELLERS 

WHO Chronicle 18(7): 275, July 1964. 

A WHO Expert Committee on Malaria whose report 
has just been published 1 draws attention to the danger 
of malaria being reintroduced by international travellers 
from malarious areas into countries from which it has 
been eradicated. It recommends that health administra- 
tions employ a card which would, with the minimum 
inconvenience, warn travellers of the danger and pro- 
vide health authorities with valuable information. The 
invitation to the traveller to report to a doctor if he has 
a fever may save his life as well as prevent possible 
transmission of malaria. Clearly such a card cannot be 
fully effective. Asymptomatic parasitaemias will escape 
notice, and many travellers will doubtless make incom- 
plete declarations on the card or fail to report to a 
doctor. 



!Wld. Hlth. Org. techn. Rep. Ser., 1964, 272. 



• While emotional stress may precipitate and accelerate the course of certain diseases, such as essential hyper- 
tension, there is as yet no evidence that it can actually cause them. 

• Recent studies carried out on more than 12,000 sera and samples of cerebrospinal fluid suggest that the fluor- 
escent treponemal antibody {FT A) test is destined to become one of the basic serological diagnostic tests for 
syphilis. 



18 



U.S. NAVY MEDICAL NEWS LETTER 




Preventive Medicine 



PUBLIC HEALTH SIGNIFICANCE OF 
ANIMAL SALMONELLOSIS 

Los Angeles County Health Index. The Public Health 
Significance of Animal Salmonellosis, Part I, 23 May 
1964, and Part II, 30 May 1964. 

Salmonellosis is a worldwide problem in both man 
and animals. There are over 700 recognized sero-types, 
nearly all of which have been found in animals. Most 
of these microorganisms are potential human patho- 
gens. The ubiquity of salmonella commands the atten- 
tion of both livestock owners and public health officials. 

The transmission of salmonella directly from animal 
reservoirs, and indirectly through food products, to man 
is widespread and is a problem of increasing impor- 
tance. Epidemiologic studies show that man may be- 
come an asymptomatic carrier of the salmonella organ- 
isms found in animals, and thereby become a source 
for animal infection. It becomes apparent that the con- 
trol of salmonellosis requires both veterinary and medi- 
cal public health measures to minimize the transfer of 
infection. 

Data have been derived from a cooperative program 
between the U. S. Department of Agriculture and the 
U. S. Public Health Service, Communicable Disease 
Center. There have been 6,216 cultures of salmonellae 
(86 different serotypes), isolated from more than 35 
different animal species. These include fowls, swine, 
sheep, goats, cattle, horses, dogs, cats and rodents. 
Fifteen serotypes comprised 82% of the total cultures. 

Salmonellosis in animals generally occurs as an in- 
testinal infection. Under certain conditions, the disease 
may progress to septicemia. Epizootics and septicemias 
are more likely to occur in young animals. Chronic, 
asymptomatic carriers are common and serve to per- 
petuate the disease and contaminate the environment. 

Avian Salmonellosis. At the present time, poultry is 
the largest known animal reservoir in the United States. 
The relatively host-specific S. pullorum and S. gallina- 
rum account for about 2/3 of avian salmonellosis. The 
ubiquitous 5. typhimurium accounts for a further 10% - 
20%. Many other serotypes occur, but represent spo- 
radic isolations, often with no manifest disease. The 
U. S. Public Health Service Communicable Disease 
Center has isolated over 50 serotypes from birds. 

In poultry, which survive pullorum disease and re- 
main carriers, the infection persists most commonly in 



the ovary, resulting in egg yolk infection. Survivors 
from salmonellosis due to other serotypes usually ex- 
perience intestinal infection. Where a chronic gall blad- 
der infection develops, fecal excretion of bacteria may 
persist for 18 months or more. Such infection results 
in contamination of the egg shell rather than the yolk. 

Porcine Salmonellosis. Swine are natural hosts of 
S. choleraesuis and may suffer from acute, subacute, or 
chronic disease known as swine paratyphoid or ne- 
crotic enteritis. S. choleraesuis is quite invasive in 
swine, often resulting in bacteremia. Apparently, 
healthy pigs may act as carriers. 

In addition to being a host to S. choleraesuis, swine 
are second only to fowls in the frequency with which 
they become infected with serotypes of salmonellae. 
Twenty-five different serotypes have been isolated by 
the Communicable Disease Center. Mixed infections 
are relatively common. 

Bovine Salmonellosis. Salmonellae affect cattle of 
all ages, the infection occurring as sporadic dysentery 
syndrome, occasionally resulting in signs of septicemia 
and intoxication. The disease in calves often spreads 
rapidly and is characterized by septicemia. 

Animals who have recovered from the illness often 
excrete salmonellae in their feces intermittently or 
regularly for long periods, and even for life. Inapparent 
or subclinical infection can also result in a carrier state. 
The persistence of these bacteria in manure is remark- 
able. S. duhlin has been viable in dried feces after 
three years and S. typhimurium has survived in water, 
pasture, and feces for periods of from 4 to 28 weeks. 

S. dublin is particularly adapted to cattle and has 
been found in many parts of the world. In the United 
States this organism seems to occur only in the West. 
Other serotypes of consequence in cattle are S. typhi- 
murium, S. newport, S. enteritidis and S. anatum. 

Ovine and Caprine Salmonellosis. The incidence of 
salmonellae in clinically normal sheep and goats ap- 
pears to be low. In addition, there is apparent rarity 
of salmonella dysentery. The cases that do develop are 
usually related to predisposing factors. 

Equine Salmonellosis. The horse is quite susceptible 
to the relatively host-specific S. abortus equi which 
causes abortion. This organism has seldom been iso- 
lated from other animal species. Occasionally, sporadic 
cases of dysentery in horses, associated with other sero- 
types have been reported. 



U.S. NAVY MEDICAL NEWS LETTER 



19 



Canine and Feline Salmonellosis, Surveys of dogs 
and cats show a varying incidence of salmonellae iso- 
lations. Out of 51 cultures, the U. S. Public Health 
Service Communicable Disease Center isolated 23 dif- 
ferent serotypes. A Los Angeles County survey, in 
1948 and 1949, revealed positive cultures from 16 of 
259 dogs and one of 75 cats. Most of those animals 
showed no illness. These animal carriers are a potential 
source of spread of salmonellosis to man and to other 
animals. 

Rodent Salmonellosis. A high incidence of S. typhi- 
murium and S. enteritidis among rodents has been 
demonstrated. Although rats and mice have a lower 
incidence of other serotypes, they may become infected 
with a wide variety of salmonellae. 

In general, every animal species is a potential source 
of salmonella infection until proven otherwise by 
thorough investigation. Salmonellae have been isolated 
from practically every animal species thus far investi- 
gated. 

Humans who must attend to farm livestock or pets 
should realize the potential risks of close contact with 
infected animals. Feces, milk, dust and other material 
may be heavily contaminated. Personal hygienic pre- 
cautions are essential. 

ANTIMONY POISONING— ILLINOIS 

Samuel L. Andelman, MD, MPH, Morbidity and Mor- 
tality Weekly Report, Antimony Poisoning — Illinois, 
13(29): 250, 24 July 1964. 

A group of 35 pre-school age children all experienced 
vomiting from 35 to 45 minutes after drinking a rasp- 
berry flavored beverage at a Chicago Sunday school 
Halloween party. Some children also became pallid, 
others dizzy. There were hospitalized for less than 24 
hours. No fatalities occurred. 

Only this drink and potato chips were served. Be- 
cause of the rapid onset of symptoms, the premises 
were carefully inspected for evidence of insecticides, 
rodenticides, and other toxic materials. None was 
found. The investigators learned that the beverage had 
been prepared by mixing the contents of several pack- 
ages of the raspberry powder with sugar and water in 
an old porcelain roasting pan, and then refrigerated for 
40 hours prior to serving. No trace of chemical could 
h* found in the powder concentrate or in the potato 
chips. Antimony was detected in the small quantity of 
remaining beverage and from acid washings of the 
pan; insufficient quantity remained for quantitative 
analysis. Accordingly, the Chicago Board of Health 
laboratory workers repeated the entire procedure, using 
the same roasting pan; 2.8 mg. percent antimony was 
detected. 

Editor's Note: Antimony is often contained in the 
binding between the enamel and metal, especially in 
older utensils. Apparently, the citric acid partially dis- 



solved the binding behind the pan's worn enamel coat, 
thus releasing sufficient antimony to cause the symp- 
toms experienced by the children. 

STUDIES ON MALARIA AND ANOPHELES 
BALABACENSIS IN CAMBODIA 

Don E. Eyles, R. H. Wharton, W. H. Cheong and 
McWilson Warren, Bulletin of WHO, Studies of Ma- 
laria and Anopheles balabacensis in Cambodia, 30(1); 
7, 1964. 

During the past few years Anopheles balabacensis 
has come to be recognized as a very important human 
malaria vector in Thailand and the Indochinese area, 
but little has been published on its bionomics except 
from North Borneo. 

Studies of the feeding habits of A. balabacensis in 
Cambodia showed it to be predominantly a forest mos- 
quito. It was readily attracted to monkeys in the forest 
canopy but also readily attacked man on the ground. 
Very few of this species were attracted to domestic 
animals. Malaria infections were found more frequently 
in mosquitos captured in villages, but a significant num- 
ber were infected from the forest beyond flight range 
of human habitation. 

The human population showed a high percentage of 
persons infected with malaria, Plasmodium falciparum 
predominating. Cambodian monkeys were found also 
to be infected with P. cynomolgi. Although none of 
thirteen monkeys injected with sporozoites from wild- 
caught mosquitos came down with malaria, it was con- 
cluded that A. balabacensis probably was the vector of 
both human and monkey malaria and that the risk of 
cross-infection was considerable if monkey malarias 
infective to man exist in the area. (Editor's Summary) 

A SAFE METHOD OF EXTRACTING 
SCORPION VENOM 

WHO Chronicle, 17(10): 383-384, October 1964. 

The preparation of scorpion antivenin requires large 
quantities of venom, which must be extracted with the 
smallest possible risk for the technicians. The results 
of a study on methods for maintaining scorpions in the 
laboratory and the electrical stimulation of the venom 
glands are described in a recent number of the Bulletin 
of the World Health Organization, Vol.. 28, page 505, 
1963. 

The scorpions were kept in large jars (sometimes as 
many as 20-25 in a single jar) containing sand and 
pieces of board and bark which they could use as 
hiding-places. Each jar was supplied with water by 
means of a Petri dish that could be filled without open- 
ing the jar. The scorpions were fed with crickets at 
the rate of one cricket each per week. 

To anesthetize the scorpions, CO., was introduced 
into the jars; this was usually effective within 3 to 5 
minutes. Each scorpion was then placed in a specially 



20 



U.S. NAVY MEDICAL NEWS LETTER 



modified mousetrap, only the telson and 1 or 2 terminal 
segments protruding beyond the cross bar of the trap. 
Next, two electrodes were applied to the postabdomen 
of the scorpion. Under this stimulation the venom 
was usually emitted immediately, a glass microscope 
slide being used to collect it. The scorpion was then 
released from the trap and transferred to a holding jar 
to await return to the original colony. It was possible 
to collect venom from as many as 400 scorpions on a 
single slide. The pooled venom could then be dried 
and preserved. 

This method made it possible to maintain a labora- 
tory colony of over 5,000 live adult scorpions and 
study the secretion and composition of the venom. 

As much as 66.4% of the venom content of the 
telson could be obtained by electrical stimulation. The 
quantity of venom secreted varied according to the 
size of the animal, the largest quantity (0.48 mg) be- 
ing obtained from Leiurus quinquestriatus, a specimen 
from Israel, and the smallest (0.075 mg) from Centru- 
roides noxius, which is found in Mexico and was the 
smallest species studied. 

ROCKY MOUNTAIN SPOTTED FEVER- 
VIRGINIA 

Commonwealth of Virginia Dept. of Health, Morbidity 
Rept. for week ended June 27, 1964. 

As of the week ended June 27, 1964 a total of 11 
cases of Rocky Mountain spotted fever has been re- 
ported in Virginia thus far in 1964. During the same 
period in 1963, reported cases totaled 8. 

During the 10-year period (1954-1963), a total of 
416 cases was reported in Virginia. Cases totaled 207 
during the first 5 years of this period (1954-1958) and 
209 during the last 5 years (1959-1963). During this 
10-year period, cases were reported during each of the 
months of the year with the peak months, July and 
August showing 99 cases each. Thirty cases were re- 
ported during May; 76 during June; 58 during Sep- 
tember, and 23 during October. During the ten year 
period, males accounted for 216 cases; females — 197 
cases. During the first five years (1954-1958) male 
cases totaled 111; females, 96; for the second five years 
(1959-1963) male cases totaled 105, females, 101. 
During the ten year period, 240 cases were under the 
age of 20 years, 173 were 20 years or older. This 
ratio was 116:91 during 1954-1958 and 124:82 during 
1959-1963. During the first 5 years, of the age group 
less than 20 years, 55 cases were females, 61 were 
males; the ratio for the last 5 years is 63 females to 
61 males. 

KNOW YOUR WORLD 

Did You Know? 

That a shipment of 400,000 doses of typhoid vaccine 
recently was sent to Bahia region in Brazil? 



A team of U. S. Public Health Service technicians 
assisted in dispensing the vaccine. The vaccine was 
a donation by a Philadelphia drug manufacturer to the 
100,000 flood victims in Brazil. (1) 



That in the widely publicized typhoid epidemic in 
Zermatt, Switzerland, in March 1963, which resulted in 
450 cases and 3 fatalities, many changes have been 
made at the resort? 

The two most important changes in sanitation were 
the incineration of garbage and erection of water puri- 
fication stations. This season their guest registry showed 
an increase of 10% in visitors. (2) 



That a total of 295 cases of tetanus were reported in 
1961 in the Central Province of Kenya? 

The wearing of shoes is an important factor in the 
prophylaxis of this disease because most of the infec- 
tions came from injuries to the feet. (3) 



That four babies, aged 5 months to 11 months are 
developing normally, both physically and mentally, al- 
though fathered by frozen sperm? 

A Philadelphia researcher of the Albert Einstein 
Medical Center, Philadelphia, reported to the meeting 
of American Society for the Study of Fertility, in Bar 
Harbour, Florida, that the freezing technique could be 
useful in establishing human sperm banks and possibly 
in the treatment of human infertility caused by low 
sperm count. Fresh human spermatozoa had been pre- 
served up to 5W months by freezing at — 321° F in 
liquid nitrogen. After thawing, there was no significant 
change in the sperm count. (4) 



That in 1963, about $356,323, or nearly 54% of the 
total claim disbursements of the Metropolitan Life In- 
surance Company were for deaths attributed to cardio- 
vascular-renal diseases? (5) 



That 23 of the 51 deaths that occurred during a 
1 0-year period among employees of the small fluorspar 
mining community in St. Lawrence, Newfoundland, 
have been due to primary lung cancer? 

The outstanding environmental factor in the fluor- 
spar mines was the discovery of concentrations of radon 
and daughter products in the air, well in excess of the 
suggested maximum permissible concentrations. On 
the basis of these concentrations and other considera- 
tions, it is suggested that underground workers were 
probably exposed to an average potential alpha-energy 
between 2.5 and 10 times the previously suggested 
working level of 1.3 x 10 s Mev per liter of air. (6) 



That 10 hours before her death from rabies, a 7- 
month pregnant woman was delivered by caesarean 
section of a live male child? 

The child was free from infection and has remained 
well for 2V4 years. (7) 



U.S. NAVY MEDICAL NEWS LETTER 



2! 



That 13 cases of leprosy were found in the village of 
Kfar Zacharia, Israel, a village founded 10 years ago 
by immigrants from Iraq? 

After a survey of 500 residents, 3 proven cases and 
1 1 suspected cases of leprosy were found, one new 
case being an 18-month-old child. It is assumed that 
the focus of the disease was probably implanted or 
imported. (8) 



References : 



1. JAMA 189(2): 176, 13 July 1964 (Canad J Publ 
HIth 55: 133 March 1964). 

2. JAMA 189(2): 175, 13 July 1964 (Med Hyg 634: 
287 March 25, 1964). 

3. J Trap Med Hyg 67: 5 Jan 1964. 

4. Science News Ltr, 85(24) : 376, 1 3 June 1964. 

5. Metropolitan Life Insurance Statistical Bull, 45: 8, 
March 1964. 

6. JAMA 189(6) : 527, 10 August 1964 (Brit J. Indus 
Med 21: 94 April 1964). 

7. Trop Dis Bull 61(6): 562, June 1964 (J Philipp 
Med Assoc 39(10): 765-767, October 1963, 3 
figs.) 

8. JAMA 189(3): 250, 20 July 1964 (Harefuah 66: 
88, 1 February 1964). 

A WORD OF WARNING ABOUT 
TULAREMIA 

Googins, John A., MD, The Monthly Bull, Indiana 
State Board of Health, November 1963. 

Tularemia is often referred to as rabbit fever, indi- 
cating long association of the disease with wild rabbits. 
However, many other animals may harbor this infec- 
tion, such as woodchuck, muskrat, opossum, squirrel 
and skunk. Studies of human cases of tularemia nearly 
always show that the victim was in contact with a wild 
rabbit. 

Tularemia, in both animals and man, is caused by a 
bacterial agent. One of the outstanding characteristics 
is the ease with which infection takes place. It is passed 
from animal to animal in nature by certain bloodsuck- 
ing insects such as ticks, lice, flies and perhaps fleas. 
Tularemia may spread from its normal animal asso- 
ciation to humans through the bite of the wood tick, 
dog tick and the blood sucking deer fly. Actual con- 
tact of the human and infected animal apparently ac- 
counts for most of the cases of tularemia. 

A frequent story given by the tularemia patient is 
that several days before he became sick, he had cleaned 
a wild rabbit. During the process a spicule of bone 
often scratches or punctures the skin of the hand which 
usually is smeared with the blood of the animal. It is 
not always necessary that the skin be penetrated by a 
bone before the disease can be acquired. A scratch or 
any break in the skin may allow ready access to the 
tularemia bacteria. In some cases there is apparently 
penetration of the unbroken skin. The germ is so 



versatile that it may enter the body in ways other than 
through the skin. A blood smeared hand may intro- 
duce the organism into the eyes. Inadequately cooked 
meat from a wild animal may allow infection via the 
intestinal tract. Water taken from a stream or spring 
contaminated with tularemia bacteria may also cause 
clinical infection. 

Symptoms of tularemia in man begin about 2 to 7 
days following the bite of the germ-carrying-insect or 
exposure to the diseased animal. The illness has a rapid 
onset, accompanied by chills, fever, headache, vomiting, 
body pains, sweating and prostration. Commonly, an 
ulcer forms at the portal of entry of the organisms 
through the skin, with ipsilateral, painful epitrochlear 
and axillary lymphadenopathy. Fever is quite often 
high throughout the course of the disease and may per- 
sist at levels of 102° to 104° F. for several weeks. 
Tularemia of gastrointestinal origin may produce symp- 
toms resembling typhoid fever, which may be quite 
severe. Recovery is generally slow, taking from 3 to 6 
months for complete recovery. 

The treatment of tularemia is made easier by several 
antibiotics. Nevertheless, the disease is still capable of 
producing prolonged illness and prostration. Untreated 
cases of tularemia have a death rate risk of about 5%. 

In view of the seriousness of tularemia, each person 
whose work or recreation brings him into contact with 
wildlife should know the following practical protective 
measures to be followed: 

1. Avoid taking animals that appear sluggish, an ani- 
mal found dead or one which has been brought in by a 
dog or cat. Sluggish or slow moving animals may have 
tularemia and there is no way of knowing what disease 
killed the animal found dead. 

2. Clean wild game with caution! Rubber or plastic 
gloves worn during the cleaning process provide excel- 
lent protection, provided they are not torn or punc- 
tured by bone fragments. Avoid splashing the blood 
of the animal. Keep the hands away from the eyes. 
Use liberal amounts of soap and water to cleanse the 
hands and arms following cleaning. This warning also 
applies to the housewife who may prepare game for 
the table after it has been refrigerated. 

3. Discard by burning or burying any game having 
white or yellow spots on the liver or other viscera, or 
enlarged glands in the neck. If the spots or enlarged 
glands are not found, it is still possible that the animal 
may have tularemia and must be handled with caution. 

4. Immediate soap and water cleaning and disinfection 
of bites, cuts, scratches and punctures should be prac- 
ticed. 

5. Avoid the bite of insects such as the tick or deer fly 
which may transmit the disease, and avoid deliberate 
handling and squashing of these insects. 

6. Cook all wild game thoroughly, not allowing any 
red juice to remain in the meat or about the bones. 

7. Avoid drinking raw water, even though crystal clear 
and remote from civilization. 



22 



U.S. NAVY MEDICAL NEWS LETTER 



The precautions listed here, if followed with care, will 
do much to prevent the serious disease tularemia from 
producing an unfortunate ending to many of the hunt- 
ing trips this fall. 

OPERATION AND CONTROL OF WATER 
TREATMENT PROCESSES 

By Charles R. Cox, Geneva, 1964, 379 pages (World 
Health Organization: Monograph Series, No. 49). WHO 
Chronicle, 18(7): 278, July 1964. 

The publication by WHO of International Standards 
for Drinking-Water was part of a programme to help 
countries improve the quality of their water supplies. 
The adoption of these standards is of little use, however, 
if the treatment processes employed are not efficient 
and the operators not sufficiently skilled. In recognition 
of the need for an authoritative guide to water treat- 
ment, WHO has now published a monograph bringing 
together a body of recent information on water treat- 
ment and control. The style of presentation is adapted 
primarily to the needs of plant superintendents, oper- 
ators, and laboratory personnel, but public health offi- 
cials and all concerned with maintaining a suitable 
system of controls will find much in the monograph to 
interest them. Sufficient theory is presented to provide 
a basic understanding of the processes described, but 
the main emphasis is on practical operating problems. 
The monograph does not aim at presenting standards 
of design — although designers will find a great deal of 
value to them — but rather seeks to show how to get the 
most from a plant already built. 

The processes described are intended solely for the 
treatment of water for domestic purposes; the treat- 
ment of water for industrial use is not considered. It 
is recognized that the limits of effectiveness of the 
various processes impose a restriction on the quality 
and character of raw waters capable of being treated 
satisfactorily. This makes it necessary to prevent pollu- 
tion of natural water resources reaching a level where 
they can no longer be treated reliably and economically 
for the production of potable water. To this end, water 
supply officials should co-operate closely, with water 
pollution control authorities. The storage of water in 
impounding reservoirs also needs careful control to 
ensure the creation of favorable conditions for self- 
purification and to prevent deterioration in water 
quality. 

Among standard treatment procedures discussed are 
aeration, taste and odor control, coagulation and floc- 
culation, sedimentation, filtration, and chlorination. 
Standards of potable water quality are summarized, 
with special reference to the prevention of water-borne 
diseases. The arguments for and against the fluorida- 
tion of water supplies as a dental health measure are 
briefly reviewed and full details are given of the prac- 
tical aspects. Information is included on corrosion con- 
trol, the removal of iron and manganese, and the 



softening and demineralization of water. Some admin- 
istrative aspects of water treatment also receive atten- 
tion, such as the keeping of adequate records and the 
qualifications, training, and utilization of personnel. 
The usefulness of the monograph as a guide for water 
treatment engineers is further heightened by the inclu- 
sion of a number of annexes containing relevant data, 
and a supplement on laboratory procedures. All meas- 
urements are given in both US and metric units, 

U. S. PRESIDENT PLEDGES SUPPORT FOR 
INTERNATIONAL TUBERCULOSIS WORK 

WHO Chronicle, 18(7): 279, July 1964. 

On the occasion of the 1964 observance of World 
Health Day, Lyndon B. Johnson, President of the USA, 
sent the following message to Dr. Abraham Horwitz, 
WHO Regional Director for the Americas: 

Tuberculosis, a disease that has plagued mankind 
since the dawn of history, is still very much with us. 
Each year, more than 50,000 cases are reported in the 
United States, at least 175,000 cases in the Western 
Hemisphere and millions around the globe. 

Science has given us powerful weap"ons with which 
to fight the disease. But these weapons must be applied 
with unceasing dedication and advances must be made 
in living standards for all people, if the world is to win 
its long struggle with tuberculosis. 

Thus the theme for this year's World Health Day 
observance on April 7, 1964, "No truce for tubercu- 
losis", is particularly fitting. I pledge the wholehearted 
co-operation of the United States in worldwide efforts 
to reduce the toll of this ancient enemy of man. 

LOCAL TREATMENT OF RABIES- 
INFECTED WOUNDS 

WHO Chronicle, 18(7): 267, July 1964. 

Prompt local treatment of all wounds inflicted by 
rabid animals — and in particular of superficial bites — 
is often decisive in blocking the spread of rabies virus 
to the central nervous system, and indeed may even 
kill the virus on the spot. The value of this first aid 
method does not appear to have been fully appreciated 
as yet. 

Together with studies on the prevention of rabies by 
vaccination and serotherapy, the results of research 
on the local treatment of rabies-infected wounds have 
frequently been published in the Bulletin of the World 
Health Organization over the past few years. Further 
studies in this field are reported in three papers in a 
recent issue. 

The authors of the first paper 1 once again stress 
the value of promptly washing scratches, lacerations, 
or superficial bites inflicted by rabid animals with tap 
water and soap or water to which a suitable chemical 
substance has been added, or of swabbing or washing 



U.S. NAVY MEDICAL NEWS LETTER 



23 



them with antirabies serum. These measures can ap- 
preciably reduce the risk of rabies infection, and are 
particularly important if there is any delay in the arrival 
of a doctor. To obtain experimental proof of the effec- 
tiveness of such local treatment, the authors inoculated 
guinea-pigs and rats with rabies virus. The animals 
were treated at varying intervals of time after inocula- 
tion and by different methods, and there was an un- 
treated control group. 

The statistical analysis of the results leaves no doubt 
as to the effectiveness of the local application of certain 
substances. Local anaesthetics in oil (particularly pro- 
caine hydrochloride and dibucaine hydrochloride) and 
benzalkonium chloride interfere with motor function 
and have a marked protective effect. Benzalkonium 
chloride seems both to have a blocking effect and to 
kill the virus on the spot. It is known that virus in- 
jected intramuscularly in animals diminishes rapidly 
in titre, but may remain viable at the site of inocula- 
tion for 49-96 hours. Accordingly, blocking agents may 
impede the transmission of virus up the nerve trunk 
long enough to allow the virus titre to drop below the 
infectious threshold. The study of this blocking effect 
and its mechanism is continuing. 

The second article 2 describes trials of the effective- 
ness of quaternary ammonium compounds, ethyl alco- 
hol, local anaesthetics, antihistamines, and tranquillizers 
in preventing the spread of rabies virus in mice infected 
by intraplantar inoculation. Only certain quaternary 
ammonium compounds and ethyl alcohol appear to in- 
hibit the spread of the virus. Although the exact mech- 



anism of action of these substances has not yet been 
elucidated, it is possible that, in the case of quaternary 
ammonium compounds, inactivation of the virus occurs 
at the point of injection and in its immediate neighbor- 
hood, for the six compounds — out of 16 studied — that 
were found to be effective in vivo were also those that 
inactivated the virus in vitro. The mode of action of 
ethyl alcohol seems to be much more complex, since a 
concentration with no virucidal action in vitro proved 
remarkably active in vivo. Moreover, the mice that 
survived developed an appreciable degree of immunity. 
Further studies will be conducted into these findings. 
Finally, a study of the effectiveness of locally inocu- 
lated antirabies serum and gamma globulin in mice 
infected by intraplantar injection 3 gave the following 
results: antirabies serum and, to a lesser extent, gamma 
globulin exert a protective action when injected at the 
same point as the rabies virus, one hour after infection. 
Some protection is also apparent when inoculations are 
made up to three hours after infection, but none could 
be demonstrated when there was a six-hour interval. 
A prophylactic injection in the opposite paw one hour 
after infection seems to have afforded a certain degree 
of protection, but a similar injection six hours after 
infection had no effect. 



'Dean, D. J., Baer, G. M. and Thompson, W. R. (1963) Bull. 
Wld Hlth Org., 28, 477. 

2 Wiktor, T. J. and Koprowski, H. (1963) Bull. Wld Hlth Org., 
28, 487. 

* Kaplan, M. M. and Paccaud, M. F. (1963) Bull. Wld Hlth Org., 
28, 495. 



MEETING OF WHO REGIONAL 
NURSING ADVISERS 

Nursing Advisers from each of the six Regional 
Offices of WHO met in Geneva from 7 to 15 July 1964 
to consider a study of the WHO nursing programme 
and the ways in which it can most effectively con- 
tribute towards the realization of the Organization's 
aims. 

Dr. Ruth Freeman, Professor of Public Health Ad- 
ministration, School of Hygiene and Public Health, 
Johns Hopkins University, USA, who acted as consult- 
ant during the study, also attended the meeting, to 
which the Nursing Advisers brought first-hand informa- 
tion on developments in nursing in Member States, 
major problems, and suggestions for the kind of as- 
sistance needed from WHO. Consideration was given 
to the need for research in nursing and it was empha- 
sized that countries should train selected nurses in re- 
search methods. 

Other items discussed included the approval of a 
technical policy on nursing that will serve as a guide 
for WHO staff members, the nursing aspects of na- 
tional health planning, recruitment, and opportunities 
for the professional development of nursing staff. 



MEDICAL EDUCATION 

IN DEVELOPING COUNTRIES 

An Inter-Regional Conference on the Establishment 
of Basic Principles for Medical Education in Develop- 
ing Countries was held from 7 to 12 September 1964 
at WHO Headquarters, Geneva. It was attended by 
24 participants from countries in the six WHO Regions 
that either give or receive assistance in medical educa- 
tion. Observers from other UN specialized agencies 
and from other interested organizations were present. 

The Conference was arranged because experi- 
ence over some years has indicated that the instruction 
given in medical schools in developing countries is often 
based on principles that seem to be at variance with 
the purpose for which the schools were established. 

It is hoped that the Conference will enable countries 
and organizations giving assistance in medical education 
and related programmes to reach a common basis of 
understanding on the steps to be taken in establishing 
programmes of medical education in developing coun- 
tries, including ways of assessing needs, formulating 
objectives, designing programmes, and selecting and 
adapting methods. 



24 



U.S. NAVY MEDICAL NEWS LETTER 




Reserve Section 



ACDUTRA ORDERS ARE STANDARDIZED 

The Naval Reservist, NavPers 15653, July 1964, 

Your orders to Active Duty for Training 
(ACDUTRA) have a new look. 

A form for ACDUTRA orders has been devised to 
standarize order writing and to simplify pay procedures. 
Several forms which have been in use and reproduced 
in the field have been consolidated into a single stand- 
ard form which is stocked in the central supply system. 
The new form provides for the computation of pay, 
allowances, and travel on the reverse side of the 
ACDUTRA orders. 

The form, ACDUTRA ORDERS & PAY VOUCH- 
ER, NavPers 4033/NavCompt Form 2120, consists of 
a carbon-interleaved pad which provides copies re- 
quired for disbursing and record purposes, plus a hecto 
master for information copies. 

The carbon set must remain intact until processed 
for payment. Disassembly and distribution of carbon 
copies will be made by the finance office. 



NEW HOSPITAL CORPS DIVISION 

The Naval Reservist, NavPers 15653, July 1964. 
Hospital Corps Division 1-2, NRTC Pawtucket, R. I., 
was recently commissioned. The mission of the new 
unit is to train hospital corpsmen and dental techni- 
cians. Included in its program is the training of Waves 
— not only in the conventional nursing skills but also 
in the concepts of environmental health sciences. 



AMERICAN COLLEGE OF SURGEONS 

A sectional meeting of the American College of 
Surgeons will be held in Chicago, Illinois, at the Con- 
rad-Hilton Hotel, during the period 5-9 October 1964. 
Naval Reserve Medical Department officers who attend 
approved sessions of this meeting are authorized to be 
granted one retirement point per day, provided they 
register their attendance at the registration desk for 
Naval Reservists. 



BUMED INSTRUCTION 1001. IB 5 August 1964 

Subj: Utilization of inactive Naval Reserve Medical 
Department officers as consultants without pay 

Ref: (a) H4207, BUPERS Manual 
(b) H2202, BUPERS Manual 

1. Purpose. To provide information concerning utili- 
zation of eligible inactive Naval Reserve Medical De- 
partment officers as consultants at naval and Marine 
Corps activities in an appropriate duty without pay 
status. The previous policy to utilize Medical Corps 
and Dental Corps officers for this purpose is expanded 
herein to include Medical Service Corps and Nurse 
Corps officers. 

2. Cancellation. BUMED Instruction 1001.1 A 
(NOTAL) is canceled. 

3. Definition. Eligible inactive Naval Reserve Medical 
Department officers may, with their consent, be ordered 
in an appropriate duty without pay status to serve at 
naval and Marine Corps activities as consultants. Their 
duties shall include, but not be limited to, those of the 
following: 

a. Participate in staff conferences, clinical lectures, 
journal club meetings, clinical pathological conferences, 
and formal ward rounds. 

b. Clinical consultant to chiefs of services, or heads 
of departments, in unusual cases, as required. 

c. Consultant-lecturer to assist in training programs. 

4. Professional and Military Standards. Consultants 
should be outstanding specialists in their community 
and diplomates of a board where appropriate. Naval 
reservists in the following categories are not eligible 
for appropriate duty orders: 

a. On the Inactive Status List. 

b. Retired with, or without, pay. 

5. Limitations. In accordance with reference (a), each 
period of appropriate duty must be at least 2 hours in 
duration and shall not exceed the following: 

Total periods per year 48 

Quarterly maximum 13 

Monthly maximum 5 

NOTE: This Instruction continues with Application 
and Assignment, Orders to Appropriate Duty, Termina- 
tion and Renewal of Assignments, and Reports. 



U.S. NAVY MEDICAL NEWS LETTER 



25 



The number of deaths from heat illness during the Mecca Pilgrimage has declined steadily from more than 450 
in 1959 to 4 in 1963 and none at all in 1964, while no cases of quarantinable disease among the pilgrims have 
been reported for several years. 

There are two schools of thought concerning the use of the term "psychosomatic" . One uses it to describe 
certain disorders in which psychological factors play a major role, while the other maintains that it applies 
to the whole field of medicine. In the opinion of a WHO Expert Committee on Mental Health, these points of 
view are not necessarily irreconcilable. 

From tests of two types of measles vaccine in Western Nigeria, it appears that the Schwarz vaccine "is likely 
to be the vaccine of choice in protecting the West African child against measles". An advantage of this vac- 
cine is that it does not have to be combined with immune serum. 



NEURO-ENDOCRINOLOGY AND 
REPRODUCTION 

A WHO Scientific Group on Neuro-endocrinology 
and Reproduction in the Human met in Geneva from 
8 to 14 September 1964. 

Neuro-endocrinology is a rapidly developing science, 
of particular importance for the understanding of hu- 
man reproduction. The Scientific Group's discussions 
covered normal and abnormal aspects of the physi- 
ology of reproduction, with special reference to lesions, 
both neoplastic and traumatic. 



PROTEIN-CALORIE MALNUTRITION 
IN AFRICA 

An inter-regional seminar on advances in the pre- 
vention and treatment of protein-calorie malnutrition 
in infants and children will be held by WHO in Kam- 
pala, Uganda, from 7 to 18 September 1964. The par- 
ticipants will be English-speaking paediatricians, mater- 
nal and child health specialists, and public health physi- 
cians from countries of Africa belonging to the African 
and Eastern Mediterranean Regions. 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER 

BETHESDA, MARYLAND 20014 

OFFICIAL BUSINESS 

PERMIT NO. I048 



POSTAGE AND FEES PAID 
NAVY DEPARTMENT 



6-01 T NOIONIHSVft *Vi$0D?X 

iviidsoH mm nvmavn 

JLHVUBIl IVDINHOgi 1VDI(I3i3 



26 



U.S. NAVY MEDICAL NEWS LETTER